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

Vivian A. Welch, Elie A. Akl, Kevin Pottie, Mohammed T. Ansari, Matthias Briel, Robin Christensen, Antonio Dans, Leonila Dans, Javier Eslava-Schmalbach, Gordon Guyatt, Monica Hultcrantz, Janet Jull, Srinivasa Vittal Katikireddi, Eddy Lang, Elizabeth Matovinovic, Joerg J. Meerpohl, Rachael L. Morton, Annhild Mosdol, M. Hassan Murad, Jennifer PetkovicHolger Schünemann, Ravi Sharaf, Bev Shea, Jasvinder A. Singh, Ivan Solà, Roger Stanev, Airton Stein, Lehana Thabaneii, Thomy Tonia, Mario Tristan, Sigurd Vitols, Joseph Watine, Peter Tugwell

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)76-83
Number of pages8
JournalJournal of Clinical Epidemiology
StatePublished - Oct 2017


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

ASJC Scopus subject areas

  • Epidemiology


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