Abstract
Objectives 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. Study Design and Setting 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. Conclusion 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.
Original language | English (US) |
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Pages (from-to) | 76-83 |
Number of pages | 8 |
Journal | Journal of Clinical Epidemiology |
Volume | 90 |
DOIs | |
State | Published - Oct 2017 |
Keywords
- Applicability
- GRADE
- Guidelines
- Health
- Indirectness
- Meta-analysis
- Subgroup analysis
- Systematic review
- equity
ASJC Scopus subject areas
- Epidemiology