A Summary of Guidance on Addressing Racial and Ethnic Health Equity in Systematic Reviews and Evidence-Based Guidelines

Racial and ethnic health equity is the absence of unfair and avoidable or remediable differences in health and well-being among persons belonging to different racial and ethnic groups. This article summarizes current guidance and identifies practices for systematic reviewers and guideline groups to develop clinical practice guidelines that mitigate such inequities. Current guidance recommends that systematic reviews and clinical practice guidelines ensure a wider perspective; identify, prioritize, and develop equity-focused topics and questions; and apply specific methods and processes to answer equity-focused questions. Ensuring a wider perspective involves incorporating persons with lived experiences and other relevant nonclinical expertise into review and guideline teams as well as engagement of patients and members of affected populations in the review and guideline process. Examples for identifying and developing equity-focused topics and questions include using health equity as a criterion to select and prioritize topics, developing topics specific to mitigating racial and ethnic health inequities, and addressing upstream drivers of inequities and implementation considerations. Appropriate methods and processes might include considering different types of study designs, selecting the type of review accordingly, and using suitable evidentiary frameworks and thresholds to answer a broader set of equity-relevant questions. Several review, health technology assessment, guideline, and other health care decision-maker groups are implementing guidance to address racial and ethnic health equity.