How health equity characteristics were reported in Chinese clinical practice guidelines




Poster session 1


Sunday 16 September 2018 - 12:30 to 14:00

All authors in correct order:

Wang X1, Chen Y1, Ke L1, Luo X1, Yao L2, Yang K1, Welch V3
1 Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
2 Clinical Division, School of Chinese Medicine, Hong Kong Baptist University, China
3 Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, Canada
Presenting author and contact person

Presenting author:

Xiaoqin Wang

Contact person:

Abstract text
To consider equity issues in clinical practice guidelines (CPGs) development and implementation has become increasingly important, although incorporating equity into guidelines remains a challenge. The number of Chinese CPGs is rising quickly every year, but no study has examined how these considered health equity when forming their recommendations.

To investigate how health equity issues were reported in recommendations from Chinese CPGs.

Using the terms “指南” and “指引”, we searched CNKI, WanFang Data and CBM from 1 January 2016 to 1 February 2018, and collected Chinese CPGs published in 2016 and 2017. After completing the screening, two independent reviewers assessed and abstracted all the guidelines with a predefined data form and according to preset criteria. The two reviewers reached consensus on results from screening, assessment, and data abstraction process. We investigated for information about the PROGRESS-Plus factors reported in recommendations, and summarized the data of the reporting characteristics as frequencies and percentages.

We identified a total of 17096 records, from which 108 (73 in 2016 and 35 in 2017) CPGs were included after screening. A total of 65 (60.2%) CPGs reported one or more (one in 54 guidelines, two in seven, and three in four) PROGRESS-Plus factors in their recommendations. The reporting of PROGRESS Plus factors was: place of residence (2, 1.9%), which included economically underdeveloped regions and locations with limited access to the intervention; race/ethnicity/culture/language (2, 1.9%), both CPGs only mentioned language; occupation (2, 1.9%); gender/sex (9, 8.3%); religion (0); education (2, 1.9%); socioeconomic position (2, 1.9%); and social capital (0). For Plus factors, only personal characteristics associated with discrimination, like age (60, 56%), and disability (1, 0.9%) were noted.

More than half of Chinese CPGs published in the 2016 and 2017 reported some factors according to PROGRESS-Plus, but only 11.1% mentioned two or three factors. Age was the most commonly reported factor in recommendations (56%); all other factors were mentioned in less than 10% of recommendations. These could to some degree, reflect the gaps concerning the reporting and awareness of equity issues and the PROGRESS-Plus framework among Chinese guideline developers.

Patient or healthcare consumer involvement:


Relevance to patients and consumers: 

Promoting health equity reflects a concern and value for distributive justice for health and health care which will directly affect patients and the public, while clinical practice guidelines are developed to assist decisions about appropriate healthcare for patients, of which developers need to consider whether the interventions or any other management options are available (and sufficiently cost-effective) for disadvantaged populations. To reasonable consider relevant aspects in clinical practice guidelines can contribute to advancing health equity for patients.