Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
Int J Equity Health. 2023 May 5;22(1):81. doi: 10.1186/s12939-023-01864-z.
The prioritisation of updating published systematic reviews of interventions is vital to prevent research waste and ensure relevance to stakeholders. The consideration of health equity in reviews is also important to ensure interventions will not exacerbate the existing inequities of the disadvantaged if universally implemented. This study aimed to pilot a priority setting exercise based on systematic reviews of interventions published in the Cochrane Library, to identify and prioritise reviews to be updated with a focus on health equity.
We conducted a priority setting exercise with a group of 13 international stakeholders. We identified Cochrane reviews of interventions that showed a reduction in mortality, had at least one Summary of Findings table and that focused on one of 42 conditions with a high global burden of disease from the 2019 WHO Global Burden of Disease report. This included 21 conditions used as indicators of success of the United Nations Universal Health Coverage in attaining the Sustainable Development Goals. Stakeholders prioritised reviews that were relevant to disadvantaged populations, or to characteristics of potential disadvantage within the general population.
After searching for Cochrane reviews of interventions within 42 conditions, we identified 359 reviews that assessed mortality and included at least one Summary of Findings table. These pertained to 29 of the 42 conditions; 13 priority conditions had no reviews with the outcome mortality. Reducing the list to only reviews showing a clinically important reduction in mortality left 33 reviews. Stakeholders ranked these reviews in order of priority to be updated with a focus on health equity.
This project developed and implemented a methodology to set priorities for updating systematic reviews spanning multiple health topics with a health equity focus. It prioritised reviews that reduce overall mortality, are relevant to disadvantaged populations, and focus on conditions with a high global burden of disease. This approach to the prioritisation of systematic reviews of interventions that reduce mortality provides a template that can be extended to reducing morbidity, and the combination of mortality and morbidity as represented in Disability-Adjusted Life Years and Quality-Adjusted Life Years.
优先更新已发表的干预措施系统评价对于防止研究浪费并确保研究与利益攸关方的相关性至关重要。在评价中考虑健康公平性也很重要，以确保如果普遍实施，干预措施不会加剧弱势群体现有的不平等。本研究旨在根据 Cochrane 图书馆发表的干预措施系统评价进行优先级设置的试点，以确定并优先考虑侧重于健康公平性的更新评价。
我们与 13 名国际利益攸关方合作开展了一项优先级设置的工作。我们确定了 Cochrane 对干预措施的评价，这些评价显示死亡率降低，至少有一个结局概要表，并且关注 2019 年世卫组织全球疾病负担报告中具有高全球疾病负担的 42 种疾病之一。这包括联合国全民健康覆盖作为实现可持续发展目标的成功指标的 21 种疾病。利益攸关方优先考虑与弱势群体或一般人群中潜在不利特征相关的评价。
在搜索了 42 种疾病的干预措施的 Cochrane 评价后，我们确定了 359 项评估死亡率并包括至少一个结局概要表的评价。这些评价涉及 42 种疾病中的 29 种；13 种优先疾病没有关于死亡率的评价。将列表缩小到仅显示临床重要的死亡率降低的评价，只剩下 33 项评价。利益攸关方根据需要更新的优先级对这些评价进行了排名，重点是健康公平性。
本项目开发并实施了一种方法，以优先考虑具有健康公平性重点的多个健康主题的系统评价更新。它优先考虑了降低总体死亡率、与弱势群体相关、并关注具有高全球疾病负担的疾病的评价。这种降低死亡率的干预措施系统评价的优先级设置方法提供了一个模板，可以扩展到降低发病率，并将死亡率和发病率结合起来，体现在残疾调整生命年和质量调整生命年中。
