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Abstract
Background: The importance of socioeconomic gradients in deter-mining health status and treatment response is recognized worldwide. Hence, it is crucial to understand how Cochrane reviews account for potential variations in the distribution of harms and benefits, especially for conditions in which large socioeconomic disparities are documented, such as chronic obstructive pulmonary disease (COPD).
Objectives: To assess to what extent Cochrane reviews for COPD describe individual study baseline data relevant to equity and incorporate these factors into the effectiveness analysis.
Methods: Electronic searches of The Cochrane Library (Issue 4, 2011) were conducted to identify reviews of effectiveness in COPD. Baseline and study outcome data reported in the reviews were classified using the PROGRESS-Plus framework, which describes factors relevant to assessing health inequities.
Results: Forty-three Cochrane COPD reviews were identified (26 pharmacological; 17 non-pharmacological). Eighty-four percent provided individual study baseline data by at least one PROGRESS-Plus factor: age (81.3%), sex (72%), place of residence, occupation, marital status and social capital (2.3% each; all in non-pharmacological reviews). Pharmacological reviews were not more likely to report equity-relevant baseline data compared to non-pharmacological reviews (odds ratio 0.2 (95% confidence interval 0.034 to 1.18)). Other equity factors (education and social exclusion) were described in the discussion of three non-pharmacological reviews but not analyzed. Three pharmacological reviews planned effectiveness subgroup analysis by age; however, none of the reviews incorporated any of the PROGRESS-Plus factors in the analysis of effectiveness.
Conclusions: Equity is seldom addressed in Cochrane COPD reviews of effectiveness. While the characteristics of age and sex are often used to describe study participants, these and other potential equity factors are consistently excluded from the analysis of therapeutic effectiveness. There is an urgent need to better synthesize the evidence of how the effectiveness of chronic disease treatments may vary according to socioeconomic disparities, especially in COPD.
Objectives: To assess to what extent Cochrane reviews for COPD describe individual study baseline data relevant to equity and incorporate these factors into the effectiveness analysis.
Methods: Electronic searches of The Cochrane Library (Issue 4, 2011) were conducted to identify reviews of effectiveness in COPD. Baseline and study outcome data reported in the reviews were classified using the PROGRESS-Plus framework, which describes factors relevant to assessing health inequities.
Results: Forty-three Cochrane COPD reviews were identified (26 pharmacological; 17 non-pharmacological). Eighty-four percent provided individual study baseline data by at least one PROGRESS-Plus factor: age (81.3%), sex (72%), place of residence, occupation, marital status and social capital (2.3% each; all in non-pharmacological reviews). Pharmacological reviews were not more likely to report equity-relevant baseline data compared to non-pharmacological reviews (odds ratio 0.2 (95% confidence interval 0.034 to 1.18)). Other equity factors (education and social exclusion) were described in the discussion of three non-pharmacological reviews but not analyzed. Three pharmacological reviews planned effectiveness subgroup analysis by age; however, none of the reviews incorporated any of the PROGRESS-Plus factors in the analysis of effectiveness.
Conclusions: Equity is seldom addressed in Cochrane COPD reviews of effectiveness. While the characteristics of age and sex are often used to describe study participants, these and other potential equity factors are consistently excluded from the analysis of therapeutic effectiveness. There is an urgent need to better synthesize the evidence of how the effectiveness of chronic disease treatments may vary according to socioeconomic disparities, especially in COPD.