Abstract：
OBJECTIVE: Actively addressing issues of equity, diversity, and inclusion (EDI) in healthcare guidelines provides an important avenue ensure that individuals and communities receive high-quality healthcare that meets their needs. In 2020, the National Clinical Evidence Taskforce was charged with developing Australian living guidelines for COVID-19 (the Guidelines). It was intended that the Guidelines would consider the biological and social determinants of health (BSDH) underpinning evidence-based recommendations for of the treatment of COVID-19. The objective of this paper is to describe the evidence available on BSDH that is reported in published trials of disease-modifying therapies for COVID-19.
METHODS: Published papers of randomized controlled trials that informed clinical recommendations (for and against drug therapies for COVID-19) in the Guidelines were reviewed retrospectively using a case series design. We extracted reported characteristics relating to BSDH. These included age, sex, gender, geographical location, ethnicity (including indigenous), disability, migrant status, income, education, employment, and social support. A descriptive analysis was conducted to illustrate the characteristics available for use in guideline development.
RESULTS: A total of 115 peer-reviewed papers describing randomized control trials of drug interventions for the treatment of COVID-19 were included. BSDH characteristics were poorly reported. Geographical location of the study was the only category reported in all papers. While age and sex were reported in most papers (n = 109 and 108, respectively), ethnicity was reported in only one-third of papers (n = 40), social support was reported in only three papers, and employment in one paper. No paper reported on gender, disability, migrant status, income, or education.
CONCLUSIONS: Consideration of EDI issues is a crucial component of guideline development. Although these issues were widely recognized to impact on health outcomes from COVID-19, reporting of these characteristics was poor in COVID trials. Urgent action is needed to improve reporting of EDI characteristics if they are to be meaningfully considered in guideline processes, and health inequity is overcome.
METHODS: Published papers of randomized controlled trials that informed clinical recommendations (for and against drug therapies for COVID-19) in the Guidelines were reviewed retrospectively using a case series design. We extracted reported characteristics relating to BSDH. These included age, sex, gender, geographical location, ethnicity (including indigenous), disability, migrant status, income, education, employment, and social support. A descriptive analysis was conducted to illustrate the characteristics available for use in guideline development.
RESULTS: A total of 115 peer-reviewed papers describing randomized control trials of drug interventions for the treatment of COVID-19 were included. BSDH characteristics were poorly reported. Geographical location of the study was the only category reported in all papers. While age and sex were reported in most papers (n = 109 and 108, respectively), ethnicity was reported in only one-third of papers (n = 40), social support was reported in only three papers, and employment in one paper. No paper reported on gender, disability, migrant status, income, or education.
CONCLUSIONS: Consideration of EDI issues is a crucial component of guideline development. Although these issues were widely recognized to impact on health outcomes from COVID-19, reporting of these characteristics was poor in COVID trials. Urgent action is needed to improve reporting of EDI characteristics if they are to be meaningfully considered in guideline processes, and health inequity is overcome.
摘要：
目标：积极解决股权问题，医疗保健指南中的多样性和包容性（EDI）提供了一个重要途径，确保个人和社区获得满足其需求的高质量医疗保健。2020年，国家临床证据工作组负责制定澳大利亚COVID-19生活指南（指南）。该指南旨在考虑健康的生物学和社会决定因素，这些因素是基于证据的COVID-19治疗建议的基础。本文的目的是描述已发表的COVID-19疾病修饰疗法试验中报告的有关健康的生物学和社会决定因素的可用证据。
方法：使用病例系列设计对指南中提供临床建议（支持和反对COVID-19的药物治疗）的随机对照试验的发表论文进行了回顾性审查。我们提取了与健康的生物学和社会决定因素有关的报告特征。这些包括：年龄，性别,性别,地理位置,种族（包括土著），残疾,移民身份,收入,教育,employment,和社会支持。进行了描述性分析，以说明可用于指南开发的特征。
结果：共纳入115篇同行评审的论文，描述了治疗COVID-19的药物干预的随机对照试验。健康特征的生物学和社会决定因素报道很少。研究的地理位置是所有论文中唯一报告的类别。虽然大多数论文报道了年龄和性别（分别为109和108）；只有三分之一的论文报道了种族（n=40），只有三篇论文报道了社会支持，一份论文报道了就业。没有关于性别的论文报道，残疾,移民身份,收入或教育。
结论：考虑EDI问题是制定指南的重要组成部分。尽管这些问题被广泛认为会影响COVID-19的健康结果，但在COVID试验中，这些特征的报告较差。如果要在指南过程中有意义地考虑EDI特征，则需要采取紧急行动来改善EDI特征的报告。并克服健康不平等。
方法：使用病例系列设计对指南中提供临床建议（支持和反对COVID-19的药物治疗）的随机对照试验的发表论文进行了回顾性审查。我们提取了与健康的生物学和社会决定因素有关的报告特征。这些包括：年龄，性别,性别,地理位置,种族（包括土著），残疾,移民身份,收入,教育,employment,和社会支持。进行了描述性分析，以说明可用于指南开发的特征。
结果：共纳入115篇同行评审的论文，描述了治疗COVID-19的药物干预的随机对照试验。健康特征的生物学和社会决定因素报道很少。研究的地理位置是所有论文中唯一报告的类别。虽然大多数论文报道了年龄和性别（分别为109和108）；只有三分之一的论文报道了种族（n=40），只有三篇论文报道了社会支持，一份论文报道了就业。没有关于性别的论文报道，残疾,移民身份,收入或教育。
结论：考虑EDI问题是制定指南的重要组成部分。尽管这些问题被广泛认为会影响COVID-19的健康结果，但在COVID试验中，这些特征的报告较差。如果要在指南过程中有意义地考虑EDI特征，则需要采取紧急行动来改善EDI特征的报告。并克服健康不平等。
