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Hawkes S, Sy EA, Barker G, Baum FE, Buse K, Chang AY, Cislaghi B, Clark J, Connell R, Cornell M, Darmstadt GL, Grilo Diniz CS, Friel S, Gupta I, Gruskin S, Hill S, Hsieh AC, Khanna R, Klugman J, Koay A, Lin V, Moalla KT, Nelson E, Robinson L, Schwalbe N, Verma R, Zarulli V. Achieving gender justice for global health equity: the Lancet Commission on gender and global health. Lancet 2025; 405:1373-1438. [PMID: 40209736 DOI: 10.1016/s0140-6736(25)00488-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 11/07/2024] [Accepted: 03/07/2025] [Indexed: 04/12/2025]
Affiliation(s)
- Sarah Hawkes
- Institute for Global Health, University College London, London, UK; Global Health 50/50, Cambridge, UK; Monash University Malaysia, Kuala Lumpur, Malaysia.
| | | | - Gary Barker
- Equimundo Center for Masculinities and Social Justice, Washington, DC, USA; Center for Social Sciences, University of Coimbra, Coimbra, Portugal
| | - Frances Elaine Baum
- Stretton Health Equity, Stretton Institute, University of Adelaide, Adelaide, SA, Australia
| | - Kent Buse
- Global Health 50/50, Cambridge, UK; Monash University Malaysia, Kuala Lumpur, Malaysia
| | - Angela Y Chang
- Danish Institute for Advanced Study and Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | | | - Jocalyn Clark
- Institute for Global Health, University College London, London, UK; British Medical Journal, London, UK; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Morna Cornell
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Gary L Darmstadt
- Department of Paediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Carmen Simone Grilo Diniz
- Department of Health and Society, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Sharon Friel
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia
| | - Indrani Gupta
- Health Policy Research Unit, Institute of Economic Growth, Delhi, India
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, Keck School of Medicine, and Gould School of Law, University of Southern California, Los Angeles, CA, USA
| | - Sarah Hill
- Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
| | | | - Renu Khanna
- Society for Health Alternatives, Vadodara, India
| | | | - Aaron Koay
- Institute for Global Health, University College London, London, UK
| | - Vivian Lin
- LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Erica Nelson
- Institute of Development Studies, University of Sussex, Brighton, UK
| | - Lynsey Robinson
- Institute of Education, Faculty of Education and Society, University College London, London, UK; Global Health 50/50, Cambridge, UK
| | - Nina Schwalbe
- Spark Street Advisors, New York, NY, USA; Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ravi Verma
- International Center for Research on Women, New Delhi, India
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Matthias K, Honekamp I, Heinrich M, De Santis KK. Consideration of Sex, Gender, or Age on Outcomes of Digital Technologies for Treatment and Monitoring of Chronic Obstructive Pulmonary Disease: Overview of Systematic Reviews. J Med Internet Res 2023; 25:e49639. [PMID: 38019578 PMCID: PMC10719824 DOI: 10.2196/49639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 09/13/2023] [Accepted: 09/26/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Several systematic reviews have addressed digital technology use for treatment and monitoring of chronic obstructive pulmonary disease (COPD). OBJECTIVE This study aimed to assess if systematic reviews considered the effects of sex, gender, or age on the outcomes of digital technologies for treatment and monitoring of COPD through an overview of such systematic reviews. The objectives of this overview were to (1) describe the definitions of sex or gender used in reviews; (2) determine whether the consideration of sex, gender, or age was planned in reviews; (3) determine whether sex, gender, or age was reported in review results; (4) determine whether sex, gender, or age was incorporated in implications for clinical practice in reviews; and (5) create an evidence map for development of individualized clinical recommendations for COPD based on sex, gender, or age diversity. METHODS MEDLINE, the Cochrane Library, Epistemonikos, Web of Science, and the bibliographies of the included systematic reviews were searched to June 2022. Inclusion was based on the PICOS framework: (1) population (COPD), (2) intervention (any digital technology), (3) comparison (any), (4) outcome (any), and (5) study type (systematic review). Studies were independently selected by 2 authors based on title and abstract and full-text screening. Data were extracted by 1 author and checked by another author. Data items included systematic review characteristics; PICOS criteria; and variables related to sex, gender, or age. Systematic reviews were appraised using A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2). Data were synthesized using descriptive statistics. RESULTS Of 1439 records, 30 systematic reviews published between 2010 and 2022 were included in this overview. The confidence in the results of 25 of the 30 (83%) reviews was critically low according to AMSTAR 2. The reviews focused on user outcomes that potentially depend on sex, gender, or age, such as efficacy or effectiveness (25/30, 83%) and acceptance, satisfaction, or adherence (3/30, 10%) to digital technologies for COPD. Reviews reported sex or gender (19/30 systematic reviews) or age (25/30 systematic reviews) among primary study characteristics. However, only 1 of 30 reviews included age in a subgroup analysis, and 3 of 30 reviews identified the effects of sex, gender, or age as evidence gaps. CONCLUSIONS This overview shows that the effects of sex, gender, or age were rarely considered in 30 systematic reviews of digital technologies for COPD treatment and monitoring. Furthermore, systematic reviews did not incorporate sex, gender, nor age in their implications for clinical practice. We recommend that future systematic reviews should (1) evaluate the effects of sex, gender, or age on the outcomes of digital technologies for treatment and monitoring of COPD and (2) better adhere to reporting guidelines to improve the confidence in review results. TRIAL REGISTRATION PROSPERO CRD42022322924; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322924. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/40538.
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Affiliation(s)
- Katja Matthias
- Faculty of Electrical Engineering and Computer Science, University of Applied Science Stralsund, Stralsund, Germany
| | - Ivonne Honekamp
- Faculty of Business, University of Applied Science Stralsund, Stralsund, Germany
| | - Monique Heinrich
- Faculty of Electrical Engineering and Computer Science, University of Applied Science Stralsund, Stralsund, Germany
| | - Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Matthias K, Honekamp I, De Santis KK. The Influence of Sex, Gender, or Age on Outcomes of Digital Technologies for Treatment and Monitoring of Chronic Obstructive Pulmonary Disease: Protocol for an Overview of Systematic Reviews. JMIR Res Protoc 2022; 11:e40538. [PMID: 36222803 PMCID: PMC9607912 DOI: 10.2196/40538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/11/2022] [Accepted: 09/21/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common chronic disease that can be treated and monitored with various digital technologies. Digital technologies offer unique opportunities for treating and monitoring people with chronic diseases, but little is known about whether the outcomes of such technologies depend on sex, gender, or age in people with COPD. OBJECTIVE The general objective of this study is to assess the possible influence of sex, gender, or age on outcomes of digital technologies for treatment and monitoring of COPD through an overview of systematic reviews. METHODS The study is planned as an overview of systematic reviews. Study reporting is based on the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines because guidelines for overviews are not available as of this writing. The information sources for the overview will include 4 bibliographic databases (MEDLINE, Cochrane Library, Epistemonikos, and Web of Science) as well as the bibliographies of the included systematic reviews. The electronic search strategy will be developed and conducted in collaboration with an experienced database specialist. The search results will be presented in accordance with the PRISMA 2020 guidelines. The eligibility of studies is based on the population, intervention, comparison, outcomes, and study design (PICOS) criteria: (1) people with COPD (population), (2) digital technology intervention for treatment or monitoring (intervention), (3) any control group or no control group (comparison), (4) any outcome, and (5) systematic review of randomized controlled trials or non-randomized controlled trials with or without a meta-analysis (study design). Critical appraisal of the included systematic reviews will be performed using A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2). Data will be extracted using a standardized data extraction sheet. RESULTS The literature search is scheduled for June 2022. We expect to select the relevant systematic reviews, code the data, and appraise the systematic reviews by December 2022. CONCLUSIONS There is a growing recognition that the influence of sex, gender, or age should be considered in research design and outcome reporting in the context of health care interventions. Our overview will identify systematic reviews of various digital technologies for treatment or monitoring of COPD. The most interesting aspect of the overview will be to investigate if any systematic reviews considered the influence of sex, gender, or age on the outcomes of such digital technologies in COPD. Evidence from the overview could be used to guide more individualized (sex, gender, or age-based) recommendations for the use of digital technologies among people with COPD. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42022322924; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322924.
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Affiliation(s)
- Katja Matthias
- Faculty of Electrical Engineering and Computer Science, University of Applied Science Stralsund, Stralsund, Germany
| | - Ivonne Honekamp
- Faculty of Business and Economics, University of Applied Science Stralsund, Stralsund, Germany
| | - Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
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Zhang J, Van Spall HGC, Wang Y, Thabane L, Wang R, Li G. Twenty-year trends in racial and ethnic enrollment in large diabetes randomized controlled trials. BMC Med 2022; 20:294. [PMID: 36109742 PMCID: PMC9479279 DOI: 10.1186/s12916-022-02501-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lack of representativeness in Black, Indigenous, and People of Colour (BIPOC) enrollment could compromise the generalizability of study results and health equity. This study aimed to examine trends in BIPOC groups enrollment in diabetes randomized controlled trials (RCTs) and to explore the association between trial factors and high-enrollment of BIPOC groups. METHODS We systematically searched the literature on large diabetes RCTs with a sample size of ≥ 400 participants published between 2000 and 2020. We assessed temporal trends in enrollment of racial and ethnic groups in the included trials. Logistic and linear regression analyses were used to explore the relationship between trial factors and the high-enrollment defined by median enrollment rate. RESULTS A total of 405 RCTs were included for analyses. The median enrollment rate of BIPOC groups was 24.0%, with 6.4% for the Black group, 11.2% for Hispanic, 8.5% for Asian, and 3.0% for other BIPOC groups respectively. Over the past 20 years, the BIPOC enrollment showed an increased trend in the diabetes RCTs, ranging from 20.1 to 28.4% (P for trend = 0.041). A significant trend towards increased enrollment for Asian group was observed. We found that weekly or daily intervention frequency (OR = 0.48, 95% CI: 0.26, 0.91) and duration of intervention > 6.5 month (OR = 0.59, 95% CI: 0.37, 0.95) were significantly related to decreased odds of high-enrollment, while type 2 diabetes (OR = 1.44, 95% CI: 1.04, 1.99) was associated with high-enrollment of BIPOC groups. CONCLUSIONS The enrollment of BIPOC was found to increase in large diabetes RCTs over the past two decades; some trial factors may be significantly associated with BIPOC enrollment. These findings may highlight the importance of enrollment of BIPOC groups and provide insights into the design and implementation of future clinical trials in diabetes.
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Affiliation(s)
- Jingyi Zhang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Yaoyao Wang
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.,St Joseph's Healthcare Hamilton, ON, Hamilton, Canada.,Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Ruoting Wang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China. .,Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada.
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