How Is Health Equity Assessed in Cochrane Musculoskeletal Reviews?

Abstract

Objective To evaluate the extent to which Cochrane Musculoskeletal systematic reviews assess and analyze health equity considerations. Methods We included Cochrane Musculoskeletal systematic reviews that included trials with participants older than 50 years published from 2015-2020. We assessed the extent to which reviews considered health equity in the description of the population in the PICO (population, intervention, comparator, and outcome) question, data analysis (planned and conducted), description of participant characteristics, summary of findings and applicability of results using the PROGRESS-Plus framework: Place of residence (rural or urban), Race/ethnicity/culture, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital–Plus: age, disability, relationship features, time-dependent relationships, comorbidities and health literacy. Results Fifty-two systematic reviews met our inclusion criteria. One or more elements of PROGRESSPlus were considered in 90% (47 reviews) in the description of participants, and 85% (44 reviews) of reviews in question formulation. For participant description, the most reported factors were age (47 reviews, 90%) and sex (45 reviews, 87%). Eight (15%) reviews planned to analyze outcomes by sex, age and comorbidities. Only one had sufficient data to carry this out. Nineteen reviews (37%) discussed the applicability of the results to one or more PROGRESSPlus factor, most frequently across sex (12 reviews, 23%) and age (9 reviews, 17%). Conclusion Sex and age are the most reported PROGRESS-Plus factors in any sections of Cochrane Musculoskeletal reviews. We suggest a template for reporting participant characteristics that authors of reviews believe may influence outcomes. This could help patients and practitioners make judgements about applicability.