Background: We developed an interactive living map that presents the latest evidence-based recommendations for the prevention and care of COVID-19 (eCOVIDRecMap). Given the inequities in the COVID-19 pandemic, guideline developers must consider equity in the issued recommendations.
Objectives: To identify COVID-19 formal recommendations and Good Practice Statements (GPS) focused on specific disadvantaged populations in eCOVIDRecMap and describe how health equity was assessed in the development of the formal recommendations.
Methods: We employed the PROGRESS-Plus framework (Place, Race, Occupation, Gender, Religion, Education, Socioeconomic Status, Social Capital, Plus for other contextual factors) to identify disadvantaged population-specific recommendations and GPS. Of those, we assessed how likely impact on health equity was assessed in the evidence to decision (EtD) frameworks of these recommendations using criteria based on differences in baseline risk, value of outcomes for disadvantaged populations, differences in the magnitude of effect, and applicability. We also assessed how equity was considered in the certainty of evidence.
Results: Of the 1,577 actionable statements published on the eCOVIDRecMap as of July 29th, 2022, we identified 310 (20%) disadvantaged population-specific actionable statements (124, 40% formal recommendations and 186, 60% GPS). Formal recommendations were most frequently focused on children (40%) followed by pregnant women (16%). GPS focused mostly on children (25%) and populations working in high-risk occupations (16%). Seventy-six percent (94/124) of the recommendations were accompanied with EtDs. More than half (55%, 52/94) of those considered indirectness of the evidence for disadvantaged populations. In most of the recommendations (49/52, 94%), the assessment led to reduction in the certainty of the evidence. Considerations in impact on health equity criterion most frequently involved implementation of the recommendation for disadvantaged populations (17%, 16/94).
Conclusions: COVID-19 recommendations focused on disadvantaged populations were developed with insufficient considerations for equity. The urgent need for guidance during the pandemic may have made the consideration of equity in the development of disadvantaged population-specific recommendations challenging. Pragmatic guidance, focused on the evidence already available, might help to overcome this limitation. Patient, public, and/or healthcare consumer involvement: Patients and healthcare consumers were involved in the development of the living recommendations map.