Nyanchoka Moriasi, Alade Omolola Titilayo, Petkovic Jennifer, Duque Tiffany, Wieland L Susan
Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya.
Global Health Program, McMaster University, Hamilton, Ontario, Canada; Faculty of Dentistry, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
J Clin Epidemiol. 2024 Dec;176:111546. doi: 10.1016/j.jclinepi.2024.111546. Epub 2024 Sep 27.
Cardiovascular disease (CVD) is the leading cause of global disease burden and rising health-care costs. Systematic reviews (SRs) rigorously evaluate evidence on health interventions' effects and guide personal, clinical, and policy decision-making. Health equity is the absence of avoidable and unfair differences in health between groups within a population. Assessing equity in lifestyle interventions for cardiovascular health is important due to persisting health inequities in CVD burden and access to interventions. We aim to explore how health equity considerations are addressed in Cochrane SRs of lifestyle interventions for cardiovascular health.
This is a methodological review of Cochrane SRs of lifestyle interventions for cardiovascular health using the PROGRESS-Plus framework. PROGRESS-Plus stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital, while "Plus" stands for additional factors associated with discrimination and exclusion such as age, disability, and comorbidity. Using predefined selection criteria, two authors independently screened all Cochrane reviews published in the Cochrane Database of Systematic Reviews (CDSR) between August 2017 and December 2022. PROGRESS-Plus factors in the SRs were sought in the Summary of Findings (SoF) table, Methods/Inclusion criteria, Methods/Subgroup analyses, Results/Included studies, Results/Subgroup analyses, and Discussion/Overall completeness and applicability of evidence.
We included 36 SRs published by 10 Cochrane groups, addressing 11 health conditions with mostly dietary and exercise interventions. The most common PROGRESS-Plus factors assessed were gender/sex, age, and comorbidity. PROGRESS-Plus factors were most addressed in the inclusion criteria (64%), the discussion (75%), and the included studies (92%) sections of the SRs. Only 33% of SoF tables referenced PROGRESS-Plus. Sixty-nine percent of the included SRs planned for subgroup analyses across one or more PROGRESS-Plus factors, but only 43% of SRs conducted subgroup analyses, suggesting limited reporting of PROGRESS-Plus factors in primary studies.
Equity factors are not sufficiently addressed in Cochrane reviews of lifestyle interventions for cardiovascular health. Low reporting of PROGRESS-Plus factors in implications for practice and research sections of Cochrane SRs limit equity-focused guidance for current clinical practice, public health interventions, and future research.
心血管疾病（CVD）是全球疾病负担和医疗保健成本不断上升的主要原因。系统评价（SRs）严格评估健康干预措施效果的证据，并指导个人、临床和政策决策。健康公平是指人群中不同群体之间不存在可避免的和不公平的健康差异。鉴于心血管疾病负担和获得干预措施方面持续存在的健康不平等现象，评估心血管健康生活方式干预措施中的公平性很重要。我们旨在探讨在Cochrane关于心血管健康生活方式干预措施的系统评价中，如何考虑健康公平问题。
这是一项使用PROGRESS-Plus框架对Cochrane关于心血管健康生活方式干预措施的系统评价进行的方法学综述。PROGRESS-Plus代表居住地、种族/族裔/文化/语言、职业、性别、宗教、教育、社会经济地位和社会资本, 而“Plus”代表与歧视和排斥相关的其他因素，如年龄、残疾和合并症。两位作者根据预先确定的选择标准，独立筛选了2017年8月至2022年12月期间发表在Cochrane系统评价数据库（CDSR）中的所有Cochrane综述。在研究结果总结（SoF）表、方法/纳入标准、方法/亚组分析、结果/纳入研究、结果/亚组分析以及讨论/证据的总体完整性和适用性中查找系统评价中的PROGRESS-Plus因素。
我们纳入了10个Cochrane小组发表的36项系统评价，涉及11种健康状况，主要是饮食和运动干预。评估的最常见的PROGRESS-Plus因素是性别、年龄和合并症。PROGRESS-Plus因素在系统评价的纳入标准部分（64%）、讨论部分（75%）和纳入研究部分（92%）中提及最多。只有33%的研究结果总结表引用了PROGRESS-Plus。69%的纳入系统评价计划对一个或多个PROGRESS-Plus因素进行亚组分析，但只有43%的系统评价进行了亚组分析，这表明在原始研究中PROGRESS-Plus因素的报告有限。
在Cochrane关于心血管健康生活方式干预措施的综述中，公平因素没有得到充分考虑。Cochrane系统评价的实践和研究部分中PROGRESS-Plus因素的低报告率限制了针对当前临床实践、公共卫生干预措施和未来研究的以公平为重点的指导。
