ABSTRACT
Background: Individuals with autoimmune infammatory rheumatic diseases (AIRDs) have an increased baseline risk of severe COVID-19 infection. Intersection of inequity factors may result in more severe adverse effects through influencing opportunities for health. We sought to examine the extent to which populations experiencing inequities were considered in studies of COVID-19 vaccination in individuals with AIRDs. Objectives: The objective of this study is to assess how health equity is considered in studies of COVID-19 vaccination studies in individuals with AIRDs. Methods: All studies (N=19) from an ongoing Cochrane living systematic review on the effects of COVID-19 vaccination in people with AIRDs were included. We identifed inequity factors using the PROGRESS-Plus framework which stands for Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital. Age, multimorbidity, and health literacy were also assessed as 'Plus' factors. We applied the framework to assess equity considerations in relation to differences in COVID-19 baseline risk, description of participant characteristics, controlling for confounding factors, subgroup analysis and applicability of study fndings. RESULTS: All nineteen studies are cohort studies that followed individuals with AIRDs after COVID-19 vaccination. Two articles (11%) described differences in baseline risk for COVID-19 across age. All nineteen studies described participant age and sex, with race/ethnicity and multimorbidity described in four (21%) and occupation in one (5%). Seven studies (37%) controlled for age and/or sex as confounding factors. Eleven studies (58%) conducted subgroup analysis across at least one PROGRESS-Plus factor, most commonly age. Eight studies (42%) discussed at least one PROGRESS-Plus factor in interpreting the applicability of results, most commonly age (32%), then race/ethnicity and multimorbidity (11%). Conclusion: It is unknown whether COVID-19 vaccine studies on individuals with AIRDs are applicable to populations experiencing inequities, as key inequity factors beyond age and sex have little to no reporting or analysis. Future COVID-19 vaccine studies should report social characteristics of participants consistently, facilitating informed decisions about the applicability of study results to the population of interest.