'Leaving no-one behind': applying an equity lens to Cochrane Eyes and Vision reviews on cataract

Tags: Oral
Evans J1, Mwangi N2, Burn H3, Ramke J1
1London School of Hygiene and Tropical Medicine, 2Department of Clinical Medicine, Kenya Medical Training College, Nairobi, 3Stoke Mandeville Hospital, Buckinghamshire Health Care Trust, Aylesbury

Background: cataract is the most important cause of blindness in the world with an estimated 20 million people blind due to cataract. Cataract blindness is unequally distributed globally, with disadvantaged populations having a higher prevalence. We investigated the extent to which Cochrane Eyes and Vision (CEV) reviews on cataract considered equity.

Methods: we identified all CEV reviews on cataract published in the Cochrane Library. We collected quantitative and qualitative data on authorship, methods, results and discussion relevant to equity and low- and middle-income countries (LMICs) using an online form. We used the PROGRESS (Place of residence, Race/culture/ethnicity, Occupation, Gender, Religion, Socio-economic status and Social capital) classification to guide data collection. We checked our data extraction for consistency with duplicate data extraction in approximately 10% of records.

Results: there are 23 published reviews on cataract in the Cochrane Library. One of these reviews specifically considered equity as a topic, with an investigation of how methods of improving access to cataract surgery impact on equity. One of the reviews was led by an LMIC author and a further three had LMIC authors on the byline. One review only (the review on equity) restricted studies to those conducted in LMICs, otherwise none of the studies used PROGRESS characteristics as inclusion or exclusion criteria. Of the 20 reviews with included studies, 16 (80%) included studies that were conducted in LMICs and six (30%) had more than half of their studies from LMICs. Just over half of reviews reported the gender of participants in the included studies (12, 52%), two reviews described race/ethnicity and the review on equity considered all of the PROGRESS characteristics. None of the included studies reported subgroup analyses by any PROGRESS characteristic, although these were planned in two studies (subgroup analyses by race/ethnicity). None of the reviews considered equity when discussing the implications of the review, other than the review on equity.

Conclusions: data on location of studies, and gender of participants, is often collected in Cochrane Reviews on cataract but other PROGRESS characteristics are not reported and the implications of the findings of the review for equity are rarely discussed. CEV review author teams could usefully consider expanding their review author teams to include researchers from LMICs to address questions relevant to lower-income settings, and to consider equity, particularly using the PROGRESS framework to report and discuss disparities, in their reviews.

Patient and public engagement: consumers were not involved in this work.