GRADE equity guidelines 3: Health equity considerations in rating the certainty of synthesized evidence

• Main Authors: Welch V., Akl E., Pottie K., Ansari M., Briel M., Christensen R., Dans A., Dans L., Eslava-Schmalbach J., Guyatt G., Hultcrantz M., Jull J., Katikireddi S., Lang E., Matovinovic E., Meerpohl J., Morton R., Mosdol A., Murad M., Petkovic J., Schünemann H., Sharaf R., Shea B., Singh J., Solà I., Stanev R., Stein A., Thabaneii L., Tonia T., Tristan M., Vitols S., Watine J., Tugwell P.
• Format: Journal
• Published: 2017
• Online Access: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85023780664&origin=inward; http://cmuir.cmu.ac.th/jspui/handle/6653943832/41182
• Institution: Chiang Mai University

© 2017 The Authors. Objectives: The aim of this paper is to describe a conceptual framework for how to consider health equity in the Grading Recommendations Assessment and Development Evidence (GRADE) guideline development process. Study Design and Setting: Consensus-based guidance developed by the GRADE working group members and other methodologists. Results: We developed consensus-based guidance to help address health equity when rating the certainty of synthesized evidence (i.e., quality of evidence). When health inequity is determined to be a concern by stakeholders, we propose five methods for explicitly assessing health equity: (1) include health equity as an outcome; (2) consider patient-important outcomes relevant to health equity; (3) assess differences in the relative effect size of the treatment; (4) assess differences in baseline risk and the differing impacts on absolute effects; and (5) assess indirectness of evidence to disadvantaged populations and/or settings. Conclusion: The most important priority for research on health inequity and guidelines is to identify and document examples where health equity has been considered explicitly in guidelines. Although there is a weak scientific evidence base for assessing health equity, this should not discourage the explicit consideration of how guidelines and recommendations affect the most vulnerable members of society.