Welch Vivian A, Akl Elie A, Pottie Kevin, Ansari Mohammed T, Briel Matthias, Christensen Robin, Dans Antonio, Dans Leonila, Eslava-Schmalbach Javier, Guyatt Gordon, Hultcrantz Monica, Jull Janet, Katikireddi Srinivasa Vittal, Lang Eddy, Matovinovic Elizabeth, Meerpohl Joerg J, Morton Rachael L, Mosdol Annhild, Murad M Hassan, Petkovic Jennifer, Schünemann Holger, Sharaf Ravi, Shea Bev, Singh Jasvinder A, Solà Ivan, Stanev Roger, Stein Airton, Thabaneii Lehana, Tonia Thomy, Tristan Mario, Vitols Sigurd, Watine Joseph, Tugwell Peter
Bruyère Research Institute, University of Ottawa and Bruyère Continuing Care, 85 Primrose Ave, Ottawa K1R 7G5, Canada.
Department of Internal Medicine, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, 1107 2020 Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
J Clin Epidemiol. 2017 Oct;90:76-83. doi: 10.1016/j.jclinepi.2017.01.015. Epub 2017 Apr 4.
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.
Consensus-based guidance developed by the GRADE working group members and other methodologists.
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.
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.
本文旨在描述一个概念框架，用于说明在分级推荐评估与发展证据（GRADE）指南制定过程中如何考量健康公平性。
由GRADE工作组成员及其他方法学家制定的基于共识的指南。
我们制定了基于共识的指南，以在对综合证据的确定性（即证据质量）进行评级时，帮助解决健康公平性问题。当利益相关者确定健康不公平是一个问题时，我们提出了五种明确评估健康公平性的方法：（1）将健康公平性作为一项结果纳入；（2）考虑与健康公平性相关的对患者重要的结果；（3）评估治疗相对效应大小的差异；（4）评估基线风险的差异以及对绝对效应的不同影响；（5）评估证据对弱势群体和/或环境的间接性。
健康不公平与指南研究的最重要优先事项是识别并记录指南中明确考虑健康公平性的实例。尽管评估健康公平性的科学证据基础薄弱，但这不应该阻碍对指南和建议如何影响社会中最脆弱成员进行明确的考量。
