Assessment of health equity consideration in Cochrane systematic reviews and primary studies on urolithiasis.

BACKGROUND AND AIMS

Health injustice is defined as "unnecessary, preventable, unjustified and unfair health differences." One of the most important scientific sources on the prevention and management of urolithiasis are Cochrane reviews in this field. Given that the first step in eliminating health injustice is to identify the causes, the aim of the present study was to evaluate equity considerations in Cochrane reviews and the included primary studies on urinary stones.

METHODS

Cochrane reviews on kidney stones and ureteral stones were searched through the Cochrane Library. The included clinical trials in each of the reviews published after 2000 were also collected. Two different researchers reviewed all the included Cochrane reviews and primary studies. The researchers reviewed each PROGRESS criteria independently (P: place of residence, R: race/ethnicity/culture, O: occupation, G: gender, R: religion, E: education, S: socioeconomic status, S: social capital and networks). The geographical location of the included studies was categorized as low-income, middle-income and high-income countries, based on the World Bank income criteria. Each PROGRESS dimension was reported for both the Cochrane reviews and the primary studies.

RESULTS

In total, 12 Cochrane reviews and 140 primary studies were included in this study. None of the included Cochrane reviews had specifically mentioned the PROGRESS framework in the Method section whereas gender distribution and place of residence were reported in two and one reviews, respectively. In 134 primary studies at least one item of PROGRESS was reported. The most frequent item was gender distribution, followed by place of residence.

CONCLUSION

According to the results of this study, the authors of Cochrane systematic reviews on urolithiasis, and researchers who have conducted such trials, have rarely considered health equity dimensions when designing and performing their studies. Therefore, researchers worldwide should be motivated to study populations from low-income countries with low socioeconomic status in addition to different cultures, ethnicities, and so forth. Furthermore, RCT reporting guidelines such as CONSORT should include health equity dimensions and the editors and reviewers of scientific journals should encourage researchers to further emphasize on health equity in their studies.