Equity issues rarely addressed in the development of COVID-19 formal recommendations and good practice statements: a cross-sectional study

Omar Dewidar; Mostafa Bondok; Leenah Abdelrazeq; Khadija Aliyeva; Karla Solo; Vivian Welch; Romina Brignardello-Petersen; Joseph L Mathew; Glen Hazlewood; Kevin Pottie; Lisa Hartling; Dina Sami Khalifa; Stephanie Duda; Maicon Falavigna; Joanne Khabsa; Tamara Lotfi; Jennifer Petkovic; Sarah Elliot; Yuan Chi; Roses Parker; Elizabeth Kristjansson; Alison Riddle; Andrea J Darzi; Olivia Magwood; Ammar Saad; Gabriel Rada; Ignacio Neumann; Mark Loeb; Ludovic Reveiz; Dominik Mertz; Thomas Piggott; Alexis F Turgeon; Holger Schünemann; Peter Tugwell

doi:10.1016/j.jclinepi.2023.08.002

Equity issues rarely addressed in the development of COVID-19 formal recommendations and good practice statements: a cross-sectional study

J Clin Epidemiol. 2023 Sep:161:116-126. doi: 10.1016/j.jclinepi.2023.08.002. Epub 2023 Aug 9.

Authors

Omar Dewidar¹, Mostafa Bondok², Leenah Abdelrazeq³, Khadija Aliyeva⁴, Karla Solo⁵, Vivian Welch⁶, Romina Brignardello-Petersen⁵, Joseph L Mathew⁷, Glen Hazlewood⁸, Kevin Pottie⁹, Lisa Hartling¹⁰, Dina Sami Khalifa⁵, Stephanie Duda⁵, Maicon Falavigna¹¹, Joanne Khabsa¹², Tamara Lotfi⁵, Jennifer Petkovic¹³, Sarah Elliot¹⁴, Yuan Chi¹⁵, Roses Parker¹⁶, Elizabeth Kristjansson¹⁷, Alison Riddle¹³, Andrea J Darzi¹⁸, Olivia Magwood¹⁹, Ammar Saad²⁰, Gabriel Rada²¹, Ignacio Neumann²², Mark Loeb²³, Ludovic Reveiz²⁴, Dominik Mertz²⁵, Thomas Piggott²⁶, Alexis F Turgeon²⁷, Holger Schünemann²⁸, Peter Tugwell²⁹

Affiliations

¹ Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: Odewi090@uottawa.ca.
² Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
³ Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Health Sciences, Carleton University, Ottawa, Ontario, Canada.
⁴ Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
⁵ Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada.
⁶ Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
⁷ Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India.
⁸ Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
⁹ Department of Family Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
¹⁰ Alberta Research Centre for Health Evidence and Cochrane Child Health, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
¹¹ National Institute for Health Technology Assessment, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
¹² Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
¹³ Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
¹⁴ Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Cochrane Child Health, Department of Pediatrics, University of Alberta, Alberta, Canada.
¹⁵ Beijing Yealth Technology Co., Ltd, Beijing, China; Cochrane Campbell Global Ageing Partnership, London, UK.
¹⁶ The Cochrane Collaboration, London, UK.
¹⁷ School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada.
¹⁸ Department of Health Research Methods, Evidence, and Impact and Anesthesia, McMaster University, Hamilton, Ontario, Canada.
¹⁹ Bruyère Research Institute, Ottawa, Ontario, Canada; Interdisciplinary School of Health Sciences, University of Ottawa, Ontario, Canada.
²⁰ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
²¹ Epistemonikos Foundation, Santiago, Chile; UC Evidence Centre, Pontificia Universidad Católica de Chile, Santiago, Chile.
²² School of Medicine, Universidad San Sebastián, Santiago, Chile.
²³ Departments of Pathology and Molecular Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
²⁴ Department of Evidence and Intelligence for Action in Health and Incident Management System for COVID-19, WHO Regional Office for the Americas/Pan American Health Organization, Washington, DC, USA.
²⁵ Department of Medicine and Department of Health Research Methods, McMaster University, Hamilton, Ontario, Canada.
²⁶ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Family Medicine, Queens University, Kingston, Ontario, Canada; Peterborough Public Health, Peterborough, Ontario, Canada.
²⁷ CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Québec City, Quebec, Canada; Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Quebec, Canada.
²⁸ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada; WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences Humanitas University, Humanitas University, Milan, Italy; Cochrane Canada, Hamilton, Ontario, Canada.
²⁹ Department of Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

PMID: 37562727
DOI: 10.1016/j.jclinepi.2023.08.002

Abstract

Background and objective: To identify COVID-19 actionable statements (e.g., recommendations) focused on specific disadvantaged populations in the living map of COVID-19 recommendations (eCOVIDRecMap) and describe how health equity was assessed in the development of the formal recommendations.

Methods: We employed the place of residence, race or ethnicity or culture, occupation, gender or sex, religion, education, socio-economic status, and social capital-Plus framework to identify statements focused on specific disadvantaged populations. We assessed health equity considerations in the evidence to decision frameworks (EtD) of formal recommendations for certainty of evidence and impact on health equity criteria according to the Grading of Recommendations, Assessment, Development, and Evaluations criteria.

Results: We identified 16% (124/758) formal recommendations and 24% (186/819) good practice statements (GPS) that were focused on specific disadvantaged populations. Formal recommendations (40%, 50/124) and GPS (25%, 47/186) most frequently focused on children. Seventy-six percent (94/124) of the recommendations were accompanied with EtDs. Over half (55%, 52/94) of those considered indirectness of the evidence for disadvantaged populations. Considerations in impact on health equity criterion most frequently involved implementation of the recommendation for disadvantaged populations (17%, 16/94).

Conclusion: Equity issues were rarely explicitly considered in the development COVID-19 formal recommendations focused on specific disadvantaged populations. Guidance is needed to support the consideration of health equity in guideline development during health emergencies.

Keywords: COVID-19; Disadvantaged populations; Equity; GRADE; Guidelines; Recommendations.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / epidemiology
Child
Cross-Sectional Studies
Health Equity*
Humans
Research Design
Social Class

Abstract

Publication types

MeSH terms

Grants and funding