The consideration of health equity by GRADE_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Zijun ¹ ^# , WANG Xiaoqin ^2,3,4 ^# , YAN Liang ⁵ , LIU Lian ¹ , WANG Hao ¹ , ZHOU Qi ⁶ ,  CHEN Yaolong ^2,3,4

1. The Second Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;
2. Evidence Based Medicine Centre, Medical College of Lanzhou University, Lanzhou, 730000, P.R.China;
3. Chinese GRADE Center, Lanzhou, 730000, P.R.China;
4. Collaborating Centre for Guideline Implementation and Knowledge Translation of WHO, Lanzhou, 730000, P.R.China;
5. Clinical Evidence Based Medical Research Institute, People’s Hospital of Gansu Province, Lanzhou, 730000, P.R.China;
6. The First Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding author：

CHEN Yaolong, Email: chenyaolong21@163.com

Keywords：

Practice guideline; Evidence-based medicine; Equity; GRADE

DOI：

10.7507/1672-2531.201709048

Video：

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The focus of health equity is to enable the public to have fair access to health services and achieve satisfactory health outcomes. With research developments, guideline developers increasingly pay more attention to the fairness in the practice guidelines and have carried out exploration and practice in the relevant guidelines. The GRADE working group has begun to investigate how to use GRADE to assess health equity in practice guidelines since 2014. In 2017, the series of methodological guidelines of health equity in guideline development was officially published. It proposed 5 approaches to evaluate health equity and pointed out current methodological challenges of applying GRADE to assess health equity. This paper aims to introduce the GRADE equity guidelines, so as to provide a reference for Chinese researchers in their practice.

Citation： WANG Zijun, WANG Xiaoqin, YAN Liang, LIU Lian, WANG Hao, ZHOU Qi, CHEN Yaolong. The consideration of health equity by GRADE. Chinese Journal of Evidence-Based Medicine, 2018, 18(7): 746-752. doi: 10.7507/1672-2531.201709048 Copy

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2.	Health impact assessment, glossary of terms. World Health Organization. Available at: http://www.who.int/hia/about/glos/en/index1.html. 2017.4.13.
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7.	Vogel TR. Update and review of racial disparities in sepsis. Surg Infect, 2012, 13(4): 203-208.
8.	Wallace R, Wallace D. Socioeconomic determinants of health: community marginalization and the diffusion of disease and disorder in the United States. BMJ, 1997, 314: 1341-1345.
9.	Eslava-Schmalbach J, Sandoval-Vargas G, Mosquera P. Incorporating equity into developing and implementing for evidence-based clinical practice guidelines. Rev Salud Publica, 2011, 13(7090): 339-351.
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14.	Oxman AD, Schünemann HJ, Fretheim A. Improving the use of research evidence in guideline development: 12. Incorporating considerations of equity. Health Res Policy Syst, 2006, 4(1): 24.
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16.	Alonso-Coello P, Schünemann HJ, Moberg J, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ, 2016, 353: i2016.
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26.	World Health Organization. Guideline: vitamin a supplementation in infants and children 6-59 months of age. Geneva, Switzerland: World Health Organization. Available at: http://apps.who.int/iris/bitstream/10665/44664/1/9789241501767_eng.pdf?ua=1&ua=1.
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28.	Greenaway C, Sandoe A, Vissandjee B, et al. Tuberculosis: evidence review for newly arriving immigrants and refugees. CMAJ, 2011, 183(12): E939-E951.
29.	Smith BD, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. Morbidity and Mortality Weekly Report: Recommendations and Reports, 2012, 61(4): 1-32.

1. Braveman P, Gruskin S. Defining equity in health. J Epidemiol Community Health, 2003, 57(4): 254-258.
2. Health impact assessment, glossary of terms. World Health Organization. Available at: http://www.who.int/hia/about/glos/en/index1.html. 2017.4.13.
3. Whitehead M. The concepts and principles of equity and health. Int J Health Serv, 1992, 22(3): 429-445.
4. 中华人民共和国卫生部, 联合国儿童基金会, 世界卫生组织, 等. 中国孕产妇和儿童生存策略研究. 北京: 中华人民共和国卫生部, 2006.
5. Alimo E, Nymann K, Klaukka T. Need, use and expenses of health services in Finland, 1964 to 1976. Helsinki: Social Insurance Institution, 1983.
6. O'Neill J, Tabish H, Welch V, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol, 2014, 67(1): 56-64.
7. Vogel TR. Update and review of racial disparities in sepsis. Surg Infect, 2012, 13(4): 203-208.
8. Wallace R, Wallace D. Socioeconomic determinants of health: community marginalization and the diffusion of disease and disorder in the United States. BMJ, 1997, 314: 1341-1345.
9. Eslava-Schmalbach J, Sandoval-Vargas G, Mosquera P. Incorporating equity into developing and implementing for evidence-based clinical practice guidelines. Rev Salud Publica, 2011, 13(7090): 339-351.
10. Aldrich R, Kemp L, Williams JS, et al. Using socioeconomic evidence in clinical practice guidelines. BMJ, 2003, 327(7426): 1283.
11. NICE. Positively equal: a guide to addressing equality issues in developing NICE clinical guidelines (Second edition). 2012.
12. Eslava-Schmalbach JH, Welch VA, Tugwell P, et al. Incorporating equity issues into the development of Colombian clinical practice guidelines: suggestions for the GRADE approach. Rev Salud Publica, 2016, 18(1): 10-12.
13. Dans AM, Dans L, Oxman AD, et al. Assessing equity in clinical practice guidelines. J Clin Epidemiol, 2007, 60(6): 540-546.
14. Oxman AD, Schünemann HJ, Fretheim A. Improving the use of research evidence in guideline development: 12. Incorporating considerations of equity. Health Res Policy Syst, 2006, 4(1): 24.
15. Tugwell P, Pottie K, Welch V, et al. Evaluation of evidence-based literature and formulation of recommendations for the clinical preventive guidelines for immigrants and refugees in Canada. CMAJ, 2011, 183(12): E933-E938.
16. Alonso-Coello P, Schünemann HJ, Moberg J, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ, 2016, 353: i2016.
17. Andrews J, Guyatt G, Oxman AD, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol, 2013, 66(7): 719-725.
18. Ueffing E, Tugwell P, Welch V, et al. Equity checklist for systematic review authors. Campbell and Cochrane Equity Methods Group, 2011.
19. Welch VA, Akl EA, Guyatt G, et al. GRADE Equity guidelines 1: Health equity in guideline development-introduction and rationale. J Clin Epidemiol, 2017, 90: 59-67.
20. Welch VA, Akl EA, Pottie K, et al. GRADE equity guidelines 3: health equity considerations in rating the certainty of synthesized evidence. J Clin Epidemiol, 2017, 90: 76-83.
21. Maternal and child nutrition. NICE public health guidance 11. London, UK: NICE. Available at: http://www.nice.org.uk/guidance/ph11/resources/guidance-maternal-andchild-nutrition-pdf.
22. Harper S, Lynch, J. Methods for measuring cancer disparities: using data relevant to healthy people 2010 cancer-related objectives. Cancer surveillance monograph series, number 6. bethesda, MD: national cancer institute. Available at: http://seer.cancer.gov/archive/publications/disparities/measuring_disparities.pdf 2005.
23. Community Preventive Services Task Force. Preventing dental caries: community water fluoridation. Available at: https://www.thecommunityguide.org/sites/default/files/assets/Oral-Health-Caries-Community-Water-Fluoridation.pdf.
24. Sun X, Briel M, Busse JW, et al. Credibility of claims of subgroup effects in randomized controlled trials: systematic review. BMJ, 2012, 344: e1553.
25. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA, 2014, 311(5): 507-520.
26. World Health Organization. Guideline: vitamin a supplementation in infants and children 6-59 months of age. Geneva, Switzerland: World Health Organization. Available at: http://apps.who.int/iris/bitstream/10665/44664/1/9789241501767_eng.pdf?ua=1&ua=1.
27. NACCHO/RACGP. National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people, 2nd ed. South Melbourne: National Aboriginal Community Controlled Health Organization (NACCHO) and The Royal Australian College of General Practitioners (RACGP). Available at: http://www.racgp.org.au/download/documents/AHU/2ndednational.
28. Greenaway C, Sandoe A, Vissandjee B, et al. Tuberculosis: evidence review for newly arriving immigrants and refugees. CMAJ, 2011, 183(12): E939-E951.
29. Smith BD, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. Morbidity and Mortality Weekly Report: Recommendations and Reports, 2012, 61(4): 1-32.

Chinese Journal of Evidence-Based Medicine

The consideration of health equity by GRADE

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