title: How effects on health equity are assessed in systematic reviews of interventions.
abstract: BACKGROUND
  Enhancing health equity has now achieved international political importance with endorsement from the World Health Assembly in 2009.  The failure of systematic reviews to consider effects on health equity is cited by decision-makers as a limitation to their ability to inform policy and program decisions.
  
  
  OBJECTIVE
  To systematically review methods to assess effects on health equity in systematic reviews of effectiveness.
  
  
  METHODS
  We searched the following databases up to July 2 2010: MEDLINE, PsychINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Index to Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on October 7 2010.
  
  
  METHODS
  We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities.
  
  
  METHODS
  Data were extracted using a pre-tested form by two independent reviewers. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews.
  
  
  RESULTS
  Thirty-four methodological studies were included.  The methods used by these included studies were: 1) Targeted approaches (n=22); 2) gap approaches (n=12) and gradient approach (n=1).  Gender or sex was assessed in eight out of 34 studies, socioeconomic status in ten studies, race/ethnicity in seven studies, age in seven studies, low and middle income countries in 14 studies, and two studies assessed multiple factors across health inequity may exist.Only three studies provided a definition of health equity. Four methodological approaches to assessing effects on health equity were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (all 34 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (12/34 studies); 3) analytic approaches (10/34 studies); and 4) applicability assessment (11/34 studies). Both analytic and applicability approaches were not reported transparently nor in sufficient detail to judge their credibility.
  
  
  CONCLUSIONS
  There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to assess and report effects on health equity in systematic reviews.
authors.affiliation: Centre for Global Health, Institute of Population Health, University of Ottawa, 1 Stewart Street, Room 206, Ottawa, Ontario, Canada, K1N 6N5.
authors.forename: Vivian
authors.initials: V
authors.lastname: Welch
authors.forename: Peter
authors.initials: P
authors.lastname: Tugwell
authors.forename: Mark
authors.initials: M
authors.lastname: Petticrew
authors.forename: Joanne
authors.initials: J
authors.lastname: de Montigny
authors.forename: Erin
authors.initials: E
authors.lastname: Ueffing
authors.forename: Betsy
authors.initials: B
authors.lastname: Kristjansson
authors.forename: Jessie
authors.initials: J
authors.lastname: McGowan
authors.forename: Maria
authors.initials: M
authors.lastname: Benkhalti Jandu
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
authors.forename: Kevin
authors.initials: K
authors.lastname: Brand
authors.forename: Janet
authors.initials: J
authors.lastname: Smylie
mesh_terms: D000367:Age Factors; D003906:Developing Countries; D005007:Ethnology; D054624:Health Status Disparities; D006801:Humans; D044469:Racial Groups; D012107:Research Design / Q000592:standards; D012196:Review Literature as Topic; D012737:Sex Factors; D012959:Socioeconomic Factors