Article type
Abstract
Background: Despite an ongoing emphasis on health equity, disparities persist. Barriers vary by population, are in many cases multifaceted, and may include access, health literacy, medical distrust, cultural or language barriers, and systemic or structural racism. Guideline developers depend on systematic reviews (SRs) to inform their recommendations. However, with a few disease-specific exceptions, very rarely are questions examining disparities included in high-quality SRs, including those performed for guideline groups. Although tools such as the PRISMA-E and PROGRESS-Plus aid in conduct and reporting, recent methodological guidance is limited.
Objectives: To describe the development of a framework for SRs of health disparities, including rationale, analytic framework, key questions and PICOTS, methods, and stakeholder engagement.
Methods: Using a lung cancer screening (LCS) living systematic review, we started with a conceptual model and framework developed in a 2006 SR examining racial and ethnic disparities in the Veterans Health Administration. The model categorizes studies as 1st, 2nd, or 3rd generation, with 1st generation studies examining disparities in intermediate outcomes such as utilization, 2nd generation examining mediating and moderating factors, and 3rd generation examining interventions designed to mitigate disparities. We revised the framework for consistency with LCS. We drafted health equity questions (HEQs) and inclusion and exclusion criteria. We sought feedback from primary care providers, experts in LCS research, and health equity experts with and without LCS expertise.
Results: Our final set of HEQs examine disparities in lung cancer (LC) incidence and prevalence and differences in the characteristics of LC (eg, histology) and LC diagnosis (eg, age, pack years, stage) among US adults with LC and rates of LCS and follow-up utilization among asymptomatic adults eligible for LCS in the US. Our final HEQ seeks to identify and describe the mediators or moderators that drive LCS disparities. Our methods include components of earlier guidance and tools (eg, GRADE equity) and more recent work by the US Preventive Services Task Force.
Conclusion: To achieve health equity, it is vital that guideline developers consider disparities when making recommendations. This framework for systematically reviewing disparities provides an option that may take us one step closer to that goal.
Objectives: To describe the development of a framework for SRs of health disparities, including rationale, analytic framework, key questions and PICOTS, methods, and stakeholder engagement.
Methods: Using a lung cancer screening (LCS) living systematic review, we started with a conceptual model and framework developed in a 2006 SR examining racial and ethnic disparities in the Veterans Health Administration. The model categorizes studies as 1st, 2nd, or 3rd generation, with 1st generation studies examining disparities in intermediate outcomes such as utilization, 2nd generation examining mediating and moderating factors, and 3rd generation examining interventions designed to mitigate disparities. We revised the framework for consistency with LCS. We drafted health equity questions (HEQs) and inclusion and exclusion criteria. We sought feedback from primary care providers, experts in LCS research, and health equity experts with and without LCS expertise.
Results: Our final set of HEQs examine disparities in lung cancer (LC) incidence and prevalence and differences in the characteristics of LC (eg, histology) and LC diagnosis (eg, age, pack years, stage) among US adults with LC and rates of LCS and follow-up utilization among asymptomatic adults eligible for LCS in the US. Our final HEQ seeks to identify and describe the mediators or moderators that drive LCS disparities. Our methods include components of earlier guidance and tools (eg, GRADE equity) and more recent work by the US Preventive Services Task Force.
Conclusion: To achieve health equity, it is vital that guideline developers consider disparities when making recommendations. This framework for systematically reviewing disparities provides an option that may take us one step closer to that goal.