title: GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence.
abstract: OBJECTIVE
  The aim of this paper is to describe a conceptual framework for how to consider health equity in the Grading Recommendations Assessment and Development Evidence (GRADE) guideline development process.
  
  
  METHODS
  Consensus-based guidance developed by the GRADE working group members and other methodologists.
  
  
  RESULTS
  We developed consensus-based guidance to help address health equity when rating the certainty of synthesized evidence (i.e., quality of evidence). When health inequity is determined to be a concern by stakeholders, we propose five methods for explicitly assessing health equity: (1) include health equity as an outcome; (2) consider patient-important outcomes relevant to health equity; (3) assess differences in the relative effect size of the treatment; (4) assess differences in baseline risk and the differing impacts on absolute effects; and (5) assess indirectness of evidence to disadvantaged populations and/or settings.
  
  
  CONCLUSIONS
  The most important priority for research on health inequity and guidelines is to identify and document examples where health equity has been considered explicitly in guidelines. Although there is a weak scientific evidence base for assessing health equity, this should not discourage the explicit consideration of how guidelines and recommendations affect the most vulnerable members of society.
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mesh_terms: D055317:Evidence-Based Practice; D000069576:Health Equity; D006801:Humans; D015201:Meta-Analysis as Topic; D017410:Practice Guidelines as Topic / Q000592:standards*; D012107:Research Design; D012196:Review Literature as Topic; D035862:Vulnerable Populations
keywords: Applicability; GRADE; Guidelines; Health; Indirectness; Meta-analysis; Subgroup analysis; Systematic review; equity