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Damned if you do, damned if you don't: subgroup analysis and equity
  1. Mark Petticrew1,
  2. Peter Tugwell2,
  3. Elizabeth Kristjansson3,
  4. Sandy Oliver4,
  5. Erin Ueffing5,
  6. Vivian Welch5
  1. 1Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  3. 3School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
  4. 4Social Sciences Research Unit, Institute of Education, University of London, London, UK
  5. 5Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Mark Petticrew, Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK; mark.petticrew{at}lshtm.ac.uk

Abstract

The final report from the WHO Commission on the social determinants of health recently noted: ‘For policy, however important an ethical imperative, values alone are insufficient. There needs to be evidence on what can be done and what is likely to work in practice to improve health and reduce health inequities.’ This is challenging, because understanding how to reduce health inequities between the poorest and better-off members of society may require a greater use of subgroup analysis to explore the differential effects of public health interventions. However, while this may produce evidence that is more policy relevant, the requisite subgroup analyses are often seen as tantamount to statistical malpractice. This paper considers some of the methodological problems with subgroup analysis, and its applicability to considerations of equity, using both clinical and public health examples. Finally, it suggests how policy needs for information on subgroups can be met while maintaining rigour.

  • Health policy
  • inequalities SI
  • public health epidemiology
  • socioeconomic
  • systematic reviews

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Footnotes

  • Funding PT is supported by a Canada Research Chair on Health Equity.

  • Competing interests None stated.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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