Is health equity considered in systematic reviews of the Cochrane Musculoskeletal Group?
OBJECTIVE
To determine whether Cochrane Musculoskeletal Group (CMSG) systematic reviews and corresponding primary studies of rheumatoid arthritis interventions report and analyze the data needed to assess the effectiveness of interventions in reducing socioeconomic differences in health and/or improving the health of the poor.


METHODS
We selected all CMSG reviews on rheumatoid arthritis published since issue 1, 2003. Fourteen reviews were identified; 147 of the 156 primary studies included in these reviews were obtained and assessed. We extracted data on whether the dimensions place of residence, race/ethnicity/culture, occupation, gender, religion, education, socioeconomic status, and social capital and networks (PROGRESS) were reported or analyzed, and whether any interventions were aimed at disadvantaged or low- and middle-income country populations.


RESULTS
Among the dimensions of PROGRESS reported at baseline in 147 primary studies, gender (89%) was the most commonly reported, followed by education (25%) and race/ethnicity (18%). Less than 50% of the systematic reviews reported dimensions of PROGRESS even when they had been reported in the primary study. Of 147 primary studies, 6 (5%) were aimed specifically at disadvantaged populations; another 6 reported on effectiveness by at least 1 dimension of PROGRESS.


CONCLUSIONS
Primary studies of interventions for rheumatoid arthritis generally reported few variables necessary to answer questions about health inequalities. Most CMSG systematic reviews failed to assess those variables even when described in the primary studies. The Cochrane Health Equity Field welcomes the opportunity to provide guidance to systematic review authors on incorporating equity considerations into their reviews.
Tugwell
Peter
P
University of Ottawa, Ottawa, Ontario, Canada. elacasse@uottawa.ca
Maxwell
Lara
L
Welch
Vivian
V
Kristjansson
Elizabeth
E
Petticrew
Mark
M
Wells
George
G
Buchbinder
Rachelle
R
Suarez-Almazor
Maria E
ME
Nowlan
Marie-Andrée
MA
Ueffing
Erin
E
Khan
Maryam
M
Shea
Bev
B
Tsikata
Setorme
S
D001172:Arthritis, Rheumatoid / Q000628:therapy*; D004522:Educational Status; D054624:Health Status Disparities; D006801:Humans; D009790:Occupations; D011287:Prejudice; D044469:Racial Groups; D012196:Review Literature as Topic; D012923:Social Class; D012959:Socioeconomic Factors