How is equity addressed in Cochrane reviews of lifestyle interventions for cardiovascular health?
2Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Kenya
3University of Ottawa, Canada
4University of Maryland School of Medicine, USA
Background: Lifestyle interventions (e.g., exercise) are often characterized as individual choices. However, the concept of health equity reflects that not everybody has the same opportunities and resources to be healthy. Lifestyle interventions are influenced by personal and environmental characteristics that affect the ability to make these choices. Systematic reviews (SRs) of interventions rigorously evaluate evidence on the effects of interventions, and are used to guide personal, clinical, and policy decisions. If SRs of lifestyle interventions do not explicitly address equity issues, this may lead to evidence being applied inappropriately to disadvantaged populations and used in a way that encourages health inequity.
Objectives: To evaluate whether and how PROGRESS-Plus factors (place of residence, race/ethnicity/culture, occupation, gender/sex, religion, education, socioeconomic status, social capital, age, comorbidity, disability) are addressed in Cochrane reviews of lifestyle interventions for cardiovascular health.
Methods: Two authors independently screened all Cochrane reviews published between August 2017 and December 2022 against predefined selection criteria (Box 1). Basic SR characteristics were extracted and PROGRESS-Plus factors were sought in the Summary of Findings (SoF) table, Methods/Inclusion criteria, Methods/Subgroup analyses, Results/Included studies, Results/Subgroup analyses, and Discussion/Overall completeness and applicability of evidence.
Results: We included 36 SRs published by 10 Cochrane groups, covering 11 different health conditions, and testing primarily diet or exercise interventions. PROGRESS-Plus factors were not mentioned in 67% of SoF tables but were present in inclusion criteria (64%), included studies (92%), and discussion sections (75%). Although subgroup analyses by PROGRESS-Plus were often planned (69%), few were conducted (44%). The most common PROGRESS-Plus factors were gender/sex, age, and comorbidity. Other factors were infrequently mentioned and some were never discussed.
Conclusions: Equity is not sufficiently addressed in Cochrane reviews of lifestyle interventions for cardiovascular health. We will present detailed data on PROGRESS-Plus factors by review question and review section, and discuss the implications of including and omitting specific PROGRESS-Plus factors in each review section.
Patient, public and/or healthcare consumer involvement: We did not involve consumers or the public. Improving how equity is addressed in health research will improve the usefulness of research to the wider patient, public, and healthcare consumer community.
Box 1 Equity in Cochrane reviews of lifestyle interventions for health February 28 2023.pdf