title: Does consideration and assessment of effects on health equity affect the conclusions of systematic reviews? A methodology study.
abstract: BACKGROUND
  Tackling health inequities both within and between countries remains high on the agenda of international organizations including the World Health Organization and local, regional and national governments. Systematic reviews can be a useful tool to assess effects on equity in health status because they include studies conducted in a variety of settings and populations. This study aims to describe the extent to which the impacts of health interventions on equity in health status are considered in systematic reviews, describe methods used, and assess the implications of their equity related findings for policy, practice and research.
  
  
  METHODS
  We conducted a methodology study of equity assessment in systematic reviews. Two independent reviewers extracted information on the reporting and analysis of impacts of health interventions on equity in health status in a group of 300 systematic reviews collected from all systematic reviews indexed in one month of MEDLINE, using a pre-tested data collection form. Any differences in data extraction were resolved by discussion.
  
  
  RESULTS
  Of the 300 systematic reviews, 224 assessed the effectiveness of interventions on health outcomes. Of these 224 reviews, 29 systematic reviews assessed effects on equity in health status using subgroup analysis or targeted analyses of vulnerable populations. Of these, seven conducted subgroup analyses related to health equity which were reported in insufficient detail to judge their credibility. Of these 29 reviews, 18 described implications for policy and practice based on assessment of effects on health equity.
  
  
  CONCLUSIONS
  The quality and completeness of reporting should be enhanced as a priority, because without this policymakers and practitioners will continue lack the evidence base they need to inform decision-making about health inequity. Furthermore, there is a need to develop methods to systematically consider impacts on equity in health status that is currently lacking in systematic reviews.
authors.affiliation: Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada. Vivian.welch@uottawa.ca
authors.forename: Vivian
authors.initials: V
authors.lastname: Welch
authors.forename: Mark
authors.initials: M
authors.lastname: Petticrew
authors.forename: Erin
authors.initials: E
authors.lastname: Ueffing
authors.forename: Maria
authors.initials: M
authors.lastname: Benkhalti Jandu
authors.forename: Kevin
authors.initials: K
authors.lastname: Brand
authors.forename: Bharbhoor
authors.initials: B
authors.lastname: Dhaliwal
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kristjansson
authors.forename: Janet
authors.initials: J
authors.lastname: Smylie
authors.forename: George Anthony
authors.initials: GA
authors.lastname: Wells
authors.forename: Peter
authors.initials: P
authors.lastname: Tugwell
mesh_terms: D014943:Global Health; D006302:Health Services Research; D054624:Health Status Disparities; D006801:Humans; D012107:Research Design; D012196:Review Literature as Topic