Gidlow Christopher J, Mankoo Aman S, Jolly Kate, Retzer Ameeta
School of Medicine, Keele University, University Road, Newcastle under Lyme ST5 5BG, UK.
Research and Innovation Department, Midlands Partnership University NHS Foundation Trust, St Georges Hospital, Corporation Street, Stafford ST16 3AG, UK.
Int J Environ Res Public Health. 2025 May 29;22(6):851. doi: 10.3390/ijerph22060851.
We present a systematic evaluation of population health reviews from the Cochrane Database (January 2013-February 2023) to evaluate how indicators of inequity or disadvantage are considered and reported in population health evidence syntheses. Descriptive analyses explored a representation of reviews across health-determinant categories (primary and secondary categories), summarised equity-focused reviews, and examined proportions and types of reviews that planned/completed a subgroup analysis using ≥1 indicators from the PROGRESS-Plus framework. Of 363 reviews included, a minority focused on interventions targeting wider determinants of health (n = 83, 22.9% as primary category), with a predominance related to individual lifestyle factors (n = 155, 42.7%) or health care services intervention (n = 97, 26.7%). An explicit equity focus was evident in 21 (5.8%) reviews that used PROGRESS/PROGRESS-Plus, and 28 (7.7%) targeting vulnerable groups. Almost half (n = 165, 45.6%) planned a subgroup analysis by ≥1 PROGRESS-Plus indicator, which was completed in 63 reviews (38.2% of 165). The non-completion of planned subgroup analyses was attributed to insufficient data (too few primary studies, data not reported by subgroups). Among the 165 reviews planning a subgroup analysis, age was the most cited indicator (n = 91, 55.2%), followed by gender/sex (n = 67, 40.6%), place (n = 47, 28.5%) and socio-economic status (n = 37, 22.4%). This study highlighted missed opportunities for learning about the impacts of health equity in population health evidence syntheses due to insufficient data. We recommend routine use of PROGRESS-Plus and greater consistency in socio-economic proxies (occupation, education, income, disadvantage measures) to facilitate meta-analyses and subgroup analyses.
我们对考科蓝数据库（2013年1月至2023年2月）中的人群健康综述进行了系统评估，以评估在人群健康证据综合分析中，不平等或劣势指标是如何被考虑和报告的。描述性分析探讨了各健康决定因素类别（主要和次要类别）中综述的呈现情况，总结了关注公平性的综述，并检查了使用PROGRESS-Plus框架中≥1个指标计划/完成亚组分析的综述的比例和类型。在纳入的363篇综述中，少数关注针对更广泛健康决定因素的干预措施（n = 83，占主要类别的22.9%），主要与个体生活方式因素（n = 155，42.7%）或医疗服务干预（n = 97，26.7%）相关。在使用PROGRESS/PROGRESS-Plus的21篇（5.8%）综述和针对弱势群体的28篇（7.7%）综述中，明确体现了对公平性的关注。近一半（n = 165，45.6%）计划按≥1个PROGRESS-Plus指标进行亚组分析，其中63篇（占165篇的38.2%）完成了分析。计划的亚组分析未完成归因于数据不足（原始研究太少，各亚组未报告数据）。在计划进行亚组分析的165篇综述中，年龄是被引用最多的指标（n = 91，55.2%），其次是性别/性（n = 67，40.6%）、地点（n = 47，28.5%）和社会经济地位（n = 37，22.4%）。这项研究强调，由于数据不足，在人群健康证据综合分析中错失了了解健康公平影响的机会。我们建议常规使用PROGRESS-Plus，并在社会经济替代指标（职业、教育、收入、劣势衡量指标）方面保持更高的一致性，以促进荟萃分析和亚组分析。
