Article type
Year
Abstract
Background: Systematic reviews have historically focused on average effects, which ignore the distribution of benefit and whether interventions benefit the poor and disadvantaged. The Cochrane Musculoskeletal Group in collaboration with the Cochrane Health Equity Field undertook a project to determine whether a sample of Musculoskeletal Group systematic reviews contain information about the effects of interventions on reducing health inequities due to socioeconomic disadvantage.
Objectives: To determine whether Cochrane Musculoskeletal Group systematic reviews on rheumatoid arthritis report and analyze the data needed to assess the effectiveness of interventions at reducing health inequities. We also assessed primary studies included in these Cochrane reviews for the same information.
Methods: We selected all Musculoskeletal Group reviews on rheumatoid arthritis published since Issue 1, 2003. 14 reviews were identified and of the 140 primary studies included in these reviews, 130 were obtained and assessed. We extracted data on whether these Cochrane reviews contained information about dimensions of socioeconomic disadvantage, using the acronym PROGRESS: Place of residence, Race/ethnicity/culture, Occupation, Gender, Religion, Education, Social capital and Socio-economic status. We also extracted the same information from the primary trials included in these systematic reviews to check whether primary trials contain PROGRESS information.
Results: Of the 14 assessed systematic reviews, 7 reported one or more PROGRESS items. Most described these in the table of included studies and reported gender. None of the systematic reviews considered effect modification across one or more PROGRESS categories. The majority of primary studies reported characteristics of the population in terms of gender and race/ethnicity. Education and occupation were the next most commonly reported items; however, these were consistently under-reported in the systematic reviews.
Conclusions: In order to effectively intervene, we need to know 'what works', in other words, which interventions are most effective in improving health of the disadvantaged and enhancing health equity? Musculoskeletal Group systematic reviews in rheumatoid arthritis under-report those PROGRESS items reported in the primary studies. The Health Equity Field can provide guidance to other Cochrane entities to ensure that consideration is given to addressing differences in treatment effectiveness by socioeconomic strata in Cochrane systematic reviews.
Objectives: To determine whether Cochrane Musculoskeletal Group systematic reviews on rheumatoid arthritis report and analyze the data needed to assess the effectiveness of interventions at reducing health inequities. We also assessed primary studies included in these Cochrane reviews for the same information.
Methods: We selected all Musculoskeletal Group reviews on rheumatoid arthritis published since Issue 1, 2003. 14 reviews were identified and of the 140 primary studies included in these reviews, 130 were obtained and assessed. We extracted data on whether these Cochrane reviews contained information about dimensions of socioeconomic disadvantage, using the acronym PROGRESS: Place of residence, Race/ethnicity/culture, Occupation, Gender, Religion, Education, Social capital and Socio-economic status. We also extracted the same information from the primary trials included in these systematic reviews to check whether primary trials contain PROGRESS information.
Results: Of the 14 assessed systematic reviews, 7 reported one or more PROGRESS items. Most described these in the table of included studies and reported gender. None of the systematic reviews considered effect modification across one or more PROGRESS categories. The majority of primary studies reported characteristics of the population in terms of gender and race/ethnicity. Education and occupation were the next most commonly reported items; however, these were consistently under-reported in the systematic reviews.
Conclusions: In order to effectively intervene, we need to know 'what works', in other words, which interventions are most effective in improving health of the disadvantaged and enhancing health equity? Musculoskeletal Group systematic reviews in rheumatoid arthritis under-report those PROGRESS items reported in the primary studies. The Health Equity Field can provide guidance to other Cochrane entities to ensure that consideration is given to addressing differences in treatment effectiveness by socioeconomic strata in Cochrane systematic reviews.