GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence.

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; ... (2017). GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence. Journal of clinical epidemiology, 90, pp. 76-83. Elsevier 10.1016/j.jclinepi.2017.01.015

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OBJECTIVES 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. STUDY DESIGN AND SETTING Consensus-based guidance developed by the GRADE working group members and other methodologists. RESULTS 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. CONCLUSION 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.

Item Type:

Journal Article (Review Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Tonia, Thomai


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services








Tanya Karrer

Date Deposited:

09 Jan 2018 12:00

Last Modified:

12 Nov 2019 02:43

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Applicability GRADE Guidelines Health Indirectness Meta-analysis Subgroup analysis Systematic review equity




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