GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence

Vivian A. Welch, Elie A. Akl, Kevin Pottie, Mohammed T. Ansari, Matthias Briel, Robin Christensen, Antonio Dans, Leonila Dans, Javier Eslava-Schmalbach, Gordon Guyatt, Monica Hultcrantz, Janet Jull, Srinivasa Vittal Katikireddi, Eddy Lang, Elizabeth Matovinovic, Joerg J. Meerpohl, Rachael L. Morton, Annhild Mosdol, Mohammad H Murad, Jennifer PetkovicHolger Schünemann, Ravi Sharaf, Bev Shea, Jasvinder A. Singh, Ivan Solà, Roger Stanev, Airton Stein, Lehana Thabaneii, Thomy Tonia, Mario Tristan, Sigurd Vitols, Joseph Watine, Peter Tugwell

Research output: Contribution to journalArticle

10 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)76-83
Number of pages8
JournalJournal of Clinical Epidemiology
Volume90
DOIs
StatePublished - Oct 1 2017

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Guidelines
Health
Vulnerable Populations
Health Equity
Research
Population
Therapeutics

Keywords

  • Applicability
  • equity
  • GRADE
  • Guidelines
  • Health
  • Indirectness
  • Meta-analysis
  • Subgroup analysis
  • Systematic review

ASJC Scopus subject areas

  • Epidemiology

Cite this

GRADE equity guidelines 3 : considering health equity in GRADE guideline development: rating the certainty of synthesized evidence. / Welch, Vivian A.; Akl, Elie A.; Pottie, Kevin; Ansari, Mohammed T.; Briel, Matthias; Christensen, Robin; Dans, Antonio; Dans, Leonila; Eslava-Schmalbach, Javier; Guyatt, Gordon; Hultcrantz, Monica; Jull, Janet; Katikireddi, Srinivasa Vittal; Lang, Eddy; Matovinovic, Elizabeth; Meerpohl, Joerg J.; Morton, Rachael L.; Mosdol, Annhild; Murad, Mohammad H; Petkovic, Jennifer; Schünemann, Holger; Sharaf, Ravi; Shea, Bev; Singh, Jasvinder A.; Solà, Ivan; Stanev, Roger; Stein, Airton; Thabaneii, Lehana; Tonia, Thomy; Tristan, Mario; Vitols, Sigurd; Watine, Joseph; Tugwell, Peter.

In: Journal of Clinical Epidemiology, Vol. 90, 01.10.2017, p. 76-83.

Research output: Contribution to journalArticle

Welch, VA, Akl, EA, Pottie, K, Ansari, MT, Briel, M, Christensen, R, Dans, A, Dans, L, Eslava-Schmalbach, J, Guyatt, G, Hultcrantz, M, Jull, J, Katikireddi, SV, Lang, E, Matovinovic, E, Meerpohl, JJ, Morton, RL, Mosdol, A, Murad, MH, Petkovic, J, Schünemann, H, Sharaf, R, Shea, B, Singh, JA, Solà, I, Stanev, R, Stein, A, Thabaneii, L, Tonia, T, Tristan, M, Vitols, S, Watine, J & Tugwell, P 2017, 'GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence', Journal of Clinical Epidemiology, vol. 90, pp. 76-83. https://doi.org/10.1016/j.jclinepi.2017.01.015
Welch, Vivian A. ; Akl, Elie A. ; Pottie, Kevin ; Ansari, Mohammed T. ; Briel, Matthias ; Christensen, Robin ; Dans, Antonio ; Dans, Leonila ; Eslava-Schmalbach, Javier ; Guyatt, Gordon ; Hultcrantz, Monica ; Jull, Janet ; Katikireddi, Srinivasa Vittal ; Lang, Eddy ; Matovinovic, Elizabeth ; Meerpohl, Joerg J. ; Morton, Rachael L. ; Mosdol, Annhild ; Murad, Mohammad H ; Petkovic, Jennifer ; Schünemann, Holger ; Sharaf, Ravi ; Shea, Bev ; Singh, Jasvinder A. ; Solà, Ivan ; Stanev, Roger ; Stein, Airton ; Thabaneii, Lehana ; Tonia, Thomy ; Tristan, Mario ; Vitols, Sigurd ; Watine, Joseph ; Tugwell, Peter. / GRADE equity guidelines 3 : considering health equity in GRADE guideline development: rating the certainty of synthesized evidence. In: Journal of Clinical Epidemiology. 2017 ; Vol. 90. pp. 76-83.
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AU - Pottie, Kevin

AU - Ansari, Mohammed T.

AU - Briel, Matthias

AU - Christensen, Robin

AU - Dans, Antonio

AU - Dans, Leonila

AU - Eslava-Schmalbach, Javier

AU - Guyatt, Gordon

AU - Hultcrantz, Monica

AU - Jull, Janet

AU - Katikireddi, Srinivasa Vittal

AU - Lang, Eddy

AU - Matovinovic, Elizabeth

AU - Meerpohl, Joerg J.

AU - Morton, Rachael L.

AU - Mosdol, Annhild

AU - Murad, Mohammad H

AU - Petkovic, Jennifer

AU - Schünemann, Holger

AU - Sharaf, Ravi

AU - Shea, Bev

AU - Singh, Jasvinder A.

AU - Solà, Ivan

AU - Stanev, Roger

AU - Stein, Airton

AU - Thabaneii, Lehana

AU - Tonia, Thomy

AU - Tristan, Mario

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AU - Watine, Joseph

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