Poor reporting limited consideration of EDI in the Australian guidelines for the clinical care of people with COVID-19

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 health care 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 underpinning evidence-based recommendations for of the treatment of COVID-19. The objective of this paper is to describe the evidence available on biological and social determinants of health that is reported in published trials of disease modifying therapies for COVID-19. Study design and setting Published papers of randomised 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 biological and social determinants of health. 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 randomised control trials of drug interventions for the treatment of COVID-19 were included. Biological and social determinants of health 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. Conclusion Consideration of EDI issues is a crucial component of guideline development. Although these issues were widely recognised 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 be overcome.