Background: Systematic reviews have historically focused on average effects, which ignore the distribution of benefits and whether interventions benefit the poor and disadvantaged. We have recently shown that community effectiveness of interventions is substantially lower in disadvantaged groups due to a staircase effect of lower coverage, poorer diagnostic accuracy, lower provider compliance and worse consumer adherence.

Objectives: This project seeks to develop and evaluate methods to assess equity implications in systematic reviews and assess the feasibility of assessing health equity in systematic reviews and the value of this equity information.

Methods: We developed an operational definition of health equity in the context of systematic reviews. We used this definition to develop an 'equity plausibility index' for whether equity should be considered for systematic reviews, based on the potential for differences in baseline risk, response and implementation across the acronym PROGRESS which stands for Place of residence (rural/urban/inner city), Race/ethnicity, Occupation, Gender, Religion, Education, Socioeconomic status and Social capital. These criteria were developed by consensus by the Cochrane Equity Field Advisory Board. We then applied these criteria to a random sample of systematic reviews from The Cochrane Library to assess inter-rater reliability. We tested the feasibility of identifying and adding health equity information to three systematic reviews identified as having potential for equity implications.

Results: We present results on inter-rater reliability for assessing equity using this equity plausibility index. The time and cost required to appraise equity implications is compared to the subjective value of including this information for decision making.

Conclusions: These equity methods can be applied to ongoing systematic reviews or retroactively to published systematic reviews to assess health equity considerations in baseline risk, response and implementation.