International Journal of Environmental Research and Public Health Article Improving Social Justice in COVID-19 Health Research: Interim Guidelines for Reporting Health Equity in Observational Studies Alba Antequera 1, * , Daeria O. Lawson 2 , Stephen G. Noorduyn 2 , Omar Dewidar 3 , Marc Avey 4 , Zulfiqar A. Bhutta 5,6 , Catherine Chamberlain 7,8 , Holly Ellingwood 9,10 , Damian Francis 11 , Sarah Funnell 12,13 , Elizabeth Ghogomu 14 , Regina Greer-Smith 15 , Tanya Horsley 3,16 , Clara Juando-Prats 17,18 , Janet Jull 19 , Elizabeth Kristjansson 20 , Julian Little 3 , Stuart G. Nicholls 21 , Miriam Nkangu 3 , Mark Petticrew 22 , Gabriel Rada 23,24 , Anita Rizvi 19 , Larissa Shamseer 25 , Melissa K. Sharp 26 , Janice Tufte 27 , Peter Tugwell 3,14,21 , Francisca Verdugo-Paiva 23,24 , Harry Wang 28 , Xiaoqin Wang 29 , Lawrence Mbuagbaw 2,† and Vivian Welch 3,14,† 1 Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain 2 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; lawsod3@mcmaster.ca (D.O.L.); noordus@mcmaster.ca (S.G.N.); mbuagblc@mcmaster.ca (L.M.) 3 Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa,   Ottawa, ON K1G 5Z3, Canada; odewi090@uottawa.ca (O.D.); thorsley@royalcollege.ca (T.H.); jlittle@uottawa.ca (J.L.); mngui058@uottawa.ca (M.N.); ptugwell@uottawa.ca (P.T.); Citation: Antequera, A.; Lawson, vwelch@campbellcollaboration.org (V.W.) D.O.; Noorduyn, S.G.; Dewidar, O.; 4 Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada; marc.t.avey@gmail.com 5 Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Avey, M.; Bhutta, Z.A.; Chamberlain, C.; Ellingwood, H.; Francis, D.; zulfiqar.bhutta@sickkids.ca 6 Institute for Global Health & Development, The Aga Khan University, Karachi 74800, Pakistan Funnell, S.; et al. Improving Social 7 School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia; Justice in COVID-19 Health Research: cacham@unimelb.edu.au Interim Guidelines for Reporting 8 Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Health Equity in Observational Perth, WA 6150, Australia Studies. Int. J. Environ. Res. Public 9 Department of Psychology, Faculty of Arts and Social Sciences, Carleton University, Health 2021, 18, 9357. https:// Ottawa, ON K1S 5B6, Canada; holly.ellingwood@carleton.ca doi.org/10.3390/ijerph18179357 10 Public Safety, Ottawa, ON K1A 0P8, Canada 11 Center for Health and Social Issues, School of Health and Human Performance, Georgia College, Academic Editors: Godfred Milledgville, GA 31061, USA; damian.francis@gcsu.edu 12 Department of Family Medicine, Queen’s University, Kingston, ON K7L 3G2, Canada; O. Boateng, Torsten B. Neilands and John Sauceda Sarah.Funnell@ottawa.ca 13 Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1G 5Z3, Canada 14 Bruyère Research Institute, University of Ottawa, Ottawa, ON K1N 5C8, Canada; Received: 27 July 2021 etanjongghogomu@bruyere.org Accepted: 1 September 2021 15 Healthcare Research Associates, LLC/The S.T.A.R. Initiative, Los Angeles, CA 90033, USA; Published: 4 September 2021 healthcareresearch@sbcglobal.net 16 Research Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, ON K1S 5N8, Canada 17 Applied Health Research Center, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in clara.juando@utoronto.ca 18 Dalla School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada published maps and institutional affil- 19 Faculty of Health Sciences, School of Rehabilitation Therapy, Queen’s University, iations. Kingston, ON K7L 3N6, Canada; janet.jull@queensu.ca (J.J.); arizv036@uottawa.ca (A.R.) 20 Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada; kristjan@uottawa.ca 21 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada; snicholls@ohri.ca Copyright: © 2021 by the authors. 22 Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Licensee MDPI, Basel, Switzerland. London WC1E 7HT, UK; mark.petticrew@lshtm.ac.uk This article is an open access article 23 Epistemonikos Foundation, Santiago 7510299, Chile; radagabriel@epistemonikos.org (G.R.); distributed under the terms and fverdugo@epistemonikos.org (F.V.-P.) conditions of the Creative Commons 24 UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile, Attribution (CC BY) license (https:// Santiago Región Metropolitana, Santiago 8331150, Chile 25 Knowledge Translation Program, Li Ka Shing Knowledge Institute, Unity Health Toronto, creativecommons.org/licenses/by/ 4.0/). Toronto, ON M5B 1T8, Canada; Larissa.Shamseer@unityhealth.to Int. J. Environ. Res. Public Health 2021, 18, 9357. https://doi.org/10.3390/ijerph18179357 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, 9357 2 of 12 26 Health Research Board Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin DO2 H638, Ireland; melissasharp@rcsi.ie 27 Hassanah Consulting, Seattle, WA 98122, USA; janicetufte@yahoo.com 28 Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; harry.wang@uottawa.ca 29 Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON L8S 4L8, Canada; wangx431@mcmaster.ca * Correspondence: alba.antequera.martin@gmail.com † These authors contributed equally to this work. Abstract: The COVID-19 pandemic has highlighted the global imperative to address health inequities. Observational studies are a valuable source of evidence for real-world effects and impacts of im- plementing COVID-19 policies on the redistribution of inequities. We assembled a diverse global multi-disciplinary team to develop interim guidance for improving transparency in reporting health equity in COVID-19 observational studies. We identified 14 areas in the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist that need additional detail to encour- age transparent reporting of health equity. We searched for examples of COVID-19 observational studies that analysed and reported health equity analysis across one or more social determinants of health. We engaged with Indigenous stakeholders and others groups experiencing health inequities to co-produce this guidance and to bring an intersectional lens. Taking health equity and social determinants of health into account contributes to the clinical and epidemiological understanding of the disease, identifying specific needs and supporting decision-making processes. Stakeholders are encouraged to consider using this guidance on observational research to help provide evidence to close the inequitable gaps in health outcomes. Keywords: health inequities; observational studies; COVID-19; guidelines; reporting; public health; vulnerable populations 1. Introduction “We are not all in the same boat. We are all in the same storm. Some are on super- yachts. Some have just the one oar” [1]—Damian Barr. The coronavirus disease (COVID-19) public health emergency has exacerbated pre- existing social, political, and economic factors driving health inequities and led to an increase in unjust and avoidable differences in health outcomes [2,3]. Furthermore, the responses to the COVID-19 pandemic from healthcare systems, governments, and suprana- tional actors have raised concerns about differential impacts across population groups [4–6]. The complex interplay of socio-political factors related to housing, employment, and public health measures have led to excess risk and burden of COVID-19 among marginalised communities [7–9]. For example, local inequalities in income and healthcare resources promote virus propagation [10], and lack of public health capacity in low-income countries hampers global coronavirus tracing [11]. Understanding the differential effects of COVID-19 on health outcomes is a prereq- uisite to adopting efficient and fair measures within our societies [12]. Evidence shows that an approach informed by an understanding of social determinants of health helps to understand the incidence and outcomes of most diseases and to address the roots of health inequities [13–15]. However, data examining the role of the social determinants of health within the context of the COVID-19 pandemic have been less prominent than research focusing on the biomedical paradigm [16,17]. A recent rapid review of COVID-19 studies examining infection, health service use, and health outcomes, found a minority of studies that had assessed outcomes according to social determinants of health [18]. Moreover, social determinants are rarely incorporated into mathematical modelling studies, which have achieved substantive importance in informing policy-makers about the impact of disease and interventions in the population over time [19,20]. Thus, these studies may Int. J. Environ. Res. Public Health 2021, 18, 9357 3 of 12 mask the differential exposure and effects across social determinants that are driving systemic inequalities [21]. Health inequities are differences in health that are avoidable and unfair [22]. Struc- tural and systemic inequities in opportunities for health shape vulnerability, defined as exposure to risk, susceptibility to disease, and capability of individuals and communities to respond [23]. For example, structural racism in medicine continues to have profound and adverse impacts on health equity [24,25]. Moreover, a distinction can be drawn between medical vulnerability (those infected individuals who experience poorer prognosis) and functional vulnerability (those individuals who are more susceptible to infection but do not necessarily have a worse prognosis [26]. Thoughtful reporting on sociodemographic data and discussion of social-ethical issues can help reveal social barriers and facilitators to inform evidence-based health policy [27]. The paucity of research examining the impact of the social determinants of health on COVID-19-relevant outcomes may, in part, be due to a lack of agreed criteria to identify populations experiencing vulnerability and information should be reported. The PROGRESS-Plus framework provides a conceptual and practical framework that researchers can use to improve the reporting of social determinants of health. In short, PROGRESS-Plus is comprised of Place of residence (e.g., urban/rural area, low and middle-income country), Race/ethnicity/culture/language, Occupation, Gender or sex, Religion, Education, Socioeconomic status, Social capital, and other contextual factors that facilitate disadvantage (e.g., disability) [28]. Social groups can experience vulnerability across multiple and intersecting PROGRESS- Plus factors. For example, nursing home staff and home care workers who lack health insurance are at high risk for exposure to coronavirus and differential healthcare access [29]. The PROGRESS-Plus framework is useful to systematically assess, synthesise, and present the evidence on the effectiveness of interventions to reduce differential impacts of ex- posures and interventions across social groups. For instance, our team has previously developed a conceptual framework for identifying and mitigating inequitable harms of COVID-19 lockdown measures [30]. Observational studies (cohorts, cross-sectional studies, case-control studies) are well- suited to study questions related to understanding health inequities such as access, imple- mentation, and adherence questions [31,32]. While well-conducted randomised clinical trials (RCTs) are often perceived to be the gold standard for assessing the efficacy of an intervention, observational studies provide evidence on long-term effects (e.g., safety) and complementary evidence of real-world effects in which inequities modify community effectiveness or implementation of interventions results in a redistribution of inequities at the population level. In the case of COVID-19, observational studies can provide evidence on the distribution of the uptake of vaccines in real-world settings across social factors such as age, sex, and socioeconomic status as well as population effectiveness across these factors [33]. Observational coronavirus-related investigations can address questions about treatment acceptability, feasibility, or unconscious bias of healthcare providers. Observa- tional research also provides insight into transmission dynamics, diagnosis, and prognosis. Furthermore, observational evaluative studies are well-suited to study COVID-19 poli- cies and other population-level interventions where evaluations capitalise on naturally occurring variations in implementation. Observational research can also be used to study the distribution of societal consequences on mental health, food insecurity, job loss, and healthcare access [34–37]. The continued public health emergency posed by the pandemic and the unjust distri- bution of the health and societal burden highlighted the vast inequities in diagnostics and vaccinations as well as solutions, both within and between countries. This motivated our global multi-disciplinary, multi-stakeholder team to develop interim guidance on trans- parency in assessing health equity in observational studies related to COVID-19 [38,39]. Reporting guidelines are an important tool to reduce research waste and promote trans- parency [40]. Endorsement of reporting guidelines results in more transparent report- ing [41]. Although collecting social data is a prerequisite, reporting them is also essential Int. J. Environ. Res. Public Health 2021, 18, 9357 4 of 12 to enable inequities in clinical and public health decisions to be targeted. We aim to extend the well-known STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines [42] to enhance transparent reporting of health equity considerations. Indigenous Peoples globally are a priority population for improving health equity, with long-standing structural inequities and lack of access to essential health determinants, including self-determination and connection to the land [43,44]. We engaged with Indige- nous scholars, citizens, and stakeholders to co-produce this guidance and appraise its relevance to research with Indigenous Peoples. Additional groups experiencing different dimensions of health inequities were engaged throughout the project to bring an intersec- tional lens. This engaged approach to partnership reinforces our aspiration to improve accountability and social justice in observational studies. 2. Materials and Methods To produce this interim guidance, we took the following steps: (1) conceptualization of the project, (2) obtaining funding, (3) registering the protocol of the project, (4) engaging a diverse team of knowledge users and citizens, (5) holding regular meetings, (6) working on interim guidelines iteratively the interim using collaborative online platforms, (7) selecting examples of COVID-19 observational studies examining any PROGRESS-Plus factor, and (8) discussing the draft and the final manuscript. The STROBE-Equity project is registered in the EQUATOR Network (Enhancing the QUAlity and Transparency Of health Research) [38], co-led by four investigators (SF, JJ, LM, VW) and funded by the Canadian Institutes of Health Research. The project is based on the methods for developing reporting guidelines described by Moher et al. [45], with modifications to include people with lived experience of inequity on the team, conduct an author survey, and seek feedback through qualitative key informant interviews [46] in order to co-produce this research with authentic partnerships that value different types of knowledge and participation. To develop this interim guidance, we formed a core writing team that met weekly and included members with expertise in Indigenous health research (AA, DOL, SGN1, OD, AR, EG, VW, LM, SGN2, LS, MKS, SF, JJ, PT, JL). We reviewed other checklists related to equity in research to develop items for the interim STROBE- Equity guidelines. We reviewed the CONSORT (Consolidated Standards of Reporting Trials)-Equity extension [47] which includes 16 extension items related to formulating equity objectives, describing ethical procedures, reporting equity analyses and interpreting equity findings. We assessed the SAGER (Sex and Gender Equity in Research) reporting guidelines [48] and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-Equity guidelines [49], both of which contain items related to evaluating equity in research [39]. We convened a citizen panel (HE, JT, RG) with lived experience of health inequities who met monthly to seek their views and engage them as citizen co-leads in designing the overall project. We then planned this study together, using conference calls, email, and an online text processor for collaborative manuscript editing. We searched for examples of COVID-19 studies using the L·OVE (Living OVerview of Evidence) platform, a system that maps questions relevant for health decision-making to a repository of studies developed by the Epistemonikos Foundation and conducts regular updates searches on COVID-19 [50]. We used the health equity typology in development to identify examples. Eligibility criteria were as follows: peer-reviewed COVID-19 obser- vational studies, either descriptive or investigating associations between exposure and health outcomes, which analysed and reported on health equity across any PROGRESS- Plus factor. We chose examples to include different types of studies (e.g., prospective vs. retrospective designs, elements of PROGRESS-Plus, sampling methods, focused and gap approaches, inclusive of high-income vs. low-income countries, and topics). We consid- ered feedback on the examples from our diverse stakeholder team regarding relevance to patients, citizens, clinicians, researchers, decision-makers, and payers of health services and research. We used these examples to inform our proposed interim STROBE-Equity Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 5 of 13 considered feedback on the examples from our diverse stakeholder team regarding rele- Int. J. Environ. Res. Public Health 2021,vance 18, 9357to 5 of 12 patients, citizens, clinicians, researchers, decision-makers, and payers of health services and research. We used these examples to inform our proposed interim STROBE- Equity guidance. We circulated the draft guidance with examples to our multidiscipli- guidance. We circulated the draft guidance with examples to our multidisciplinary, global nary, global steering committees on technical oversight, knowledge users, Indigenous re- steering committees on technical oversight, knowledge users, Indigenous research, and search, and citizen and public engagement to engage broader feedback. citizen and public engagement to engage broader feedback. 3. 3. Results Results We identified 14 We identified 14areas areasininthe theSTROBE STROBEchecklist checklistthat that need need additional additional detail detail to encour- to encourage age transparent reporting of health equity (Figure 1). Table S1 (Supplementary transparent reporting of health equity (Figure 1). Table S1 (Supplementary material) material) pre- sents the full preliminary checklist of possible items for STROBE-Equity presents the full preliminary checklist of possible items for STROBE-Equity reporting reporting guide- lines. These These guidelines. items include description items include of the of description population acrossacross the population relevant healthhealth relevant equityequity char- acteristics characteristics using the PROGRESS-Plus factors as well as sampling methods to reach and using the PROGRESS-Plus factors as well as sampling methods to reach and include include populations populations who who experience experience vulnerability. vulnerability. As As with with CONSORT-Equity, CONSORT-Equity, informedinformed consent, consent, research research accountability, accountability, and and ethics ethics procedures procedures needneed toto be be reported reported for for all all studies studies that that include populations who experience vulnerability and health inequities to promote include populations who experience vulnerability and health inequities to promote “never “never about us, without about us, without us”. us”. Studies Studies that that include include people people experiencing experiencing inequity inequity need need toto report report methods methods toto determine determine thethe relevance relevance of of outcomes outcomes for for these these populations populations and and collect collect relevant relevant socio-demographic socio-demographic and and contextual contextual information information forfor analysis. analysis. Methods Methods to to analyse analyse differential exposure, differential susceptibility and differential capacity to respond differential exposure, differential susceptibility and differential capacity to respond need needto to be planned and described. Finally, implications of exclusion, missingness, be planned and described. Finally, implications of exclusion, missingness, or exclusion of or exclusion of people people experiencing experiencing inequities inequities need need to to be be discussed. discussed. Figure 1. Figure Possible items 1. Possible items for for STROBE- STROBE- Equity Equity reporting reporting guidelines. Abbreviations: PROGRESS-Plus, guidelines. Abbreviations: PROGRESS-Plus, Place Place of of residence, residence, Race/ethnicity/culture/language, Occupation, Gender or sex, Religion, Education, Socioeconomic status, Social Race/ethnicity/culture/language, Occupation, Gender or sex, Religion, Education, Socioeconomic status, Social capital,capital, and other contextual and other factors contextual that that factors facilitate disadvantage. facilitate disadvantage. We identified We identifiedexamples examplesofofCOVID-19 COVID-19observational observational studies studies with with an an explicit explicit focus focus on on evaluating effects across one or more PROGRESS-Plus factors and summarised evaluating effects across one or more PROGRESS-Plus factors and summarised these these ex- examples amples of of specific specific questions questions andtransparent and transparentreporting reportingofofhealth healthequity equity considerations. considerations. Table 1 displays examples of focused and gap approaches across PROGRESS-Plus Table 1 displays examples of focused and gap approaches across PROGRESS-Plus factors in factors low- in andand low- middle-income middle-income countries andand countries high-income countries. high-income We defined countries. gap approach We defined gap ap- as using subgroup analysis or meta-regression to explore differential effects, proach as using subgroup analysis or meta-regression to explore differential effects, whereas focused approach examines populations experiencing inequity to assess effectiveness of interventions. The examples also include different types of observational studies detailed in STROBE guidelines. Figure 2 summarises the risk for COVID-19 disease (exposure or susceptibility—i.e., differential effect including infection and recovery) and implications for healthcare access for each PROGRESS-Plus factor. Int. J. Environ. Res. Public Health 2021, 18, 9357 6 of 12 Table 1. Examples of COVID-19 observational studies. PROGRESS- Context Gap or Focus Differences in Level of Country Topic Health Research Question Study Plus Factors Analysis Data Source Approaches * Design Opportunities What is the characterisation of United spatial inequities in States Incidence Differential COVID-19 testing, Place of Group Zip code Gap exposure and positivity, confirmed residence Testing Ecological tabulation access susceptibility cases, and mortality area during the first 6 months of the pandemic? [51] Are there England differences in risk of Hospital hospitalisation with Race, ethnicity, Differential severe COVID-19 Mixed: culture, or Individual and primary Gap Prognosis and/or cohort and language susceptibility case-control care health in-hospital mortality records across ethnic groups? [52] What is the effectiveness of an integrated infection control surveillance Infection system among Italy prevention Prospective Occupation Focus Differential healthcare workers Individual Ad hoc exposure involved in the first and cohort database management of control suspected or confirmed COVID-19 patients? [53] 19 countries from Africa, Asia, Are demographics, Europe, including gender, North Cross- Gender Group America, Gap Vaccination Differential independently and South acceptability associated with sectional America vaccine Country- acceptance? [54] level data What are symptoms Sweden, associated with United short and long Prospective Sex Individual Kingdon, Gap Prognosis Differential susceptibility COVID adjusting cohort United States for sex and age? [55] Ethiopia City-level Knowledge, What are factors attitudes, Differential associated with Cross- Religion Individual urban, Gap perception toward sectional percep- acceptability community- tions COVID-19? [56] based What are sociodemographic characteristics, Italy including education City-level level, associated Gap Differential with COVID-19 Cross- Education Individual Hospital Prevalence exposure sectional health disease among records pregnant females admitted to hospital for pregnancy health care? [57] Int. J. Environ. Res. Public Health 2021, 18, 9357 7 of 12 Table 1. Cont. PROGRESS- Context Gap or Focus Differences in Level of Country Topic Health Research Question Study Plus Factors Analysis Data Source Approaches * Design Opportunities What is the Peru seroprevalence of City-level, SARS-CoV-2 Socioeconomic Population- Gap Differential antibodies in Lima Cross- status Individual Prevalence exposure [stratified by sectional based socioeconomic survey status and other variables]? [58] What is the impact France Population- Differential of lockdown policies Group Gap Policy community Cross- Social capital on different social sectional based impact survey effectiveness classes in France? [59] Are social Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW determinants of Differential 6 of 13 children’s health exposure and Individual Spain Focus Policy unequally equity Cross- Plus sectional Children impact distributed during distribution effects the COVID-19 whereas focused approach examines populations experiencing inequity lockdown? [60] to assess effec- tiveness of interventions. The examples also include different Differential types of observational stud- What is the burden Indigenous ies Brazil detailed in STROBE guidelines. Figure 2 summarises exposure and ofthe risk for COVID-19 onCOVID-19 the disease Individual Nationwide Focus Incidence Indigenous Cohort Peoples (exposure accessibility to register or susceptibility—i.e., differential effect including infection and recovery) and healthcare population? [61] implications for healthcare access for each PROGRESS-Plus factor. Abbreviations: SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. * Definition provided by Welch and colleagues [62]; gap: study evaluates inequities between groups (e.g., across gender), focus: study evaluates inequities only in a group experiencing vulnerability (e.g., essential workers). Figure 2. Figure Risk for 2. Risk for COVID-19 COVID-19 infection infection and and implications implications for for healthcare healthcare access access across across PROGRESS-Plus PROGRESS-Plus factors. factors. Table 1. Examples of COVID-19 observational studies. Gap or Differences Level of Context PROGRESS- Focus in Health Analysi Country Topic Research Question Study Design Plus Factors Approac Opportunitie s Data Source hes * s Int. J. Environ. Res. Public Health 2021, 18, 9357 8 of 12 The components of the PROGRESS-Plus framework are interdependent, and the COVID-19 pandemic has made such interdependence explicit. For instance, South African women have decreased health access compared to men, especially striking among women without post-secondary education [63], or access to the COVID-19 vaccine when schedul- ing relies on technology is challenging for rural areas and lower-income neighbourhoods within high-income countries [64]. Interactions and intersections of the PROGRESS-Plus factors may amplify disparities (e.g., race and gender, or level of education, incomes, and work conditions), while some may mitigate the effect of others (e.g., social capital). Supplementary material provides a comprehensive description of the rationale and rele- vance to the COVID-19 pandemic and additional examples are also outlined in the Table S2 (Supplementary material). 4. Discussion The COVID-19 pandemic has aggravated pre-existing inequities and their effects on health outcomes and societal burden. This interim guidance proposes a structure for applying an equity lens to observational studies by using the well-established PROGRESS- Plus framework. The practical examples strive to illustrate equity considerations in clinical and public health studies and ultimately guide key stakeholders interested in mitigating health inequities. We identified 14 items across six domains of the STROBE checklist that need to be adapted to ensure transparent reporting of health equity. Western-oriented knowledge and approaches have often reproduced the dynamics of structural oppression systems (racism, colonialism, patriarchy, capitalism, etc.) [65,66]. Thus, the evidence derived from these methodologies is at risk of disregarding the needs of health care and values and preferences of most of the population that, in turn, is composed of a diverse mosaic of groups experiencing multiple axes of disadvantage [67–69]. Addressing the social determinants of health as root causes of COVID-19 inequities also involves health professional education, both in undergraduate and postgraduate stages, which tends to explain the complex health–disease processes as mainly relying on the biomedicine model. Medical conferences also need to integrate into the discussion of biomedical information the etiopathogenic role and clinical and social consequences of social determinants of health. Over the last decades, a number of frameworks have advanced a better understanding of differential health outcomes [48,70,71], highlighting the role of research in identifying and addressing inequity [22,72]. Routine consideration of drivers of health inequities contributes to generating evidence for accountability in evolving political, social, and economic challenges and helps policymakers prioritise actions to maximize both overall population health and the distribution of health in the population [73]. Moreover, frame- works outlining unintended and inequitably distributed harmful impacts may facilitate the development of mitigating strategies [30]. The integration of equity issues requires creative approaches to capture different social dimensions and develop transformative insights [71,74]. For example, training in the conduct of research with Indigenous com- munities, and drawing attention to who is or is not involved in the research process, including use of the GRIPP (Guidance for Reporting Involvement of Patients and Pub- lic) [75] checklist or SAGER guideline [48] required by journals. Broadening research communities and involving more diverse voices may contribute to integrating equity in health research and subsequent decision-making [76,77]. Reporting guidelines have been developed to assist researchers who conduct systematic reviews and RCTs in identifying, extracting, and interpreting evidence on equity [47,49]. Given the fact that the impacts of the COVID-19 pandemic are unevenly and unjustly distributed across groups, it may be critical to appraise equity considerations in any observational investigation whose assessed phenomena might influence health outcomes (e.g., examining unconscious bias regarding racism among clinicians). The STROBE-Equity project is engaged in a comprehensive process to enhance transparency and completeness of reporting of equity considerations in observational studies. Acknowledging that this task requires engaging multiple stakehold- Int. J. Environ. Res. Public Health 2021, 18, 9357 9 of 12 ers, we call upon interested clinicians, researchers, editors, funding agencies, the public, and policy-makers to join by contacting us through our Open Science Framework project (https://osf.io/h57se/) (accessed on 22 June 2021) [38]. 5. Conclusions Given the magnitude of inequities in health and the societal burden of COVID-19, applying an equity lens to observational research can contribute to a better understanding of who may experience vulnerability, including exposure to the virus, response to treat- ment, community effectiveness, and the consequences of public health policies and other measures. We propose this interim guidance as a structure for integrating an equity lens within the design, analysis, and interpretation and reporting of results in observational research. We identified 14 areas in the STROBE checklist that need additional detail to encourage transparent reporting of health equity; we also described examples that anal- ysed and reported on health equity across social determinants of health. This interim guidance serves as a starting point for clinicians, researchers, decision-makers, and funders in considering what needs to be reported to close the inequitable gaps in health outcomes. The consensus process that is planned for STROBE-Equity extension will further develop parsimonious, evidence-based guidance. Supplementary Materials: The following are available online at https://www.mdpi.com/article/ 10.3390/ijerph18179357/s1, Table S1: Checklist of possible items for STROBE-Equity reporting guidelines, Table S2: Additional examples of COVID-19 observational studies. Author Contributions: Conceptualization V.W., L.M., S.F., J.J., J.L. and M.P.; methodology, A.A., D.O.L., S.G.N. (Stephen G Noorduyn), O.D., A.R., E.G., V.W., L.M., S.G.N. (Stuart G Nicholls), L.S., M.K.S., S.F., J.J., P.T. and J.L.; software, F.V.-P. and G.R.; investigation, A.A., D.O.L., S.G.N. (Stephen G Noorduyn), O.D., A.R., E.G., V.W., L.M., S.F., J.J., P.T., J.L. and H.W.; writing—original draft preparation, A.A.; writing—review and editing, A.A, D.O.L., S.G.N. (Stephen G Noorduyn), O.D., M.A., Z.A.B., C.C., H.E., D.F., S.F., E.G., R.G.-S., T.H., C.J.-P., J.J., E.K., J.L., S.G.N. (Stuart G Nicholls), M.N., M.P., G.R., A.R., L.S., M.K.S., J.T., P.T., F.V.-P., H.W., X.W., L.M. and V.W.; visualization, A.A.; supervision, V.W. and L.M.; project administration, V.W. and A.R.; funding acquisition, V.W., L.M., J.J. and S.F. All authors have read and agreed to the published version of the manuscript. Funding: The STROBE-Equity was funded by the Canadian Institutes Health Research (reference number 173269). AA was funded by the Instituto de Salud Carlos III through the “Acción Estratégica en Salud 2013–2016/Contratos Río Hortega call 2018/CM18/00141” (Co-funded by European Social Fund 2014–2020, “Investing in your future”). Institutional Review Board Statement: Not applicable. Informed Consent Statement: Not applicable. Data Availability Statement: No new data were created or analysed in this study. Data sharing is not applicable to this article. Conflicts of Interest: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. References 1. Barr, D. We Are Not All in the Same Boat. We Are All in the Same Storm. 2021. Available online: https://www.damianbarr.com/ latest/https/we-are-not-all-in-the-same-boat (accessed on 10 June 2021). 2. Bambra, C.; Riordan, R.; Ford, J.; Ford, J.; Matthews, F. The COVID-19 pandemic and health inequalities. J. Epidemiol. Community Health 2020, 74, 964–968. [CrossRef] [PubMed] 3. Marmot, M.; Allen, J. COVID-19: Exposing and amplifying inequalities. J. Epidemiol. Community Health 2020, 74, 681–682. [CrossRef] [PubMed] 4. World Health Organization. Addressing Human Rights as Key to the COVID-19 Response. 2021. Available online: https://www. who.int/publications/i/item/addressing-human-rights-as-key-to-the-\unhbox\voidb@x\hbox{COVID-19}-response (accessed on 10 June 2021). Int. J. Environ. Res. Public Health 2021, 18, 9357 10 of 12 5. Burstrom, B.; Tao, W. Social determinants of health and inequalities in COVID-19. Eur. J. Public Health 2020, 30, 617–618. [CrossRef] 6. Seligman, B.; Ferranna, M.; Bloom, D.E. Social determinants of mortality from COVID-19: A simulation study using NHANES. PLoS Med. 2021, 18, e1003490. [CrossRef] [PubMed] 7. Razai, M.S.; Kankam, H.K.N.; Majeed, A.; Esmail, A.; Williams, D.R. Mitigating ethnic disparities in COVID-19 and beyond. BMJ 2021, 372. [CrossRef] 8. Germain, S.; Yong, A. COVID-19 Highlighting Inequalities in Access to Healthcare in England: A Case Study of Ethnic Minority and Migrant Women. Fem. Leg. Stud. 2020, 28, 301–310. [CrossRef] [PubMed] 9. Franco-Paredes, C.; Jankousky, K.; Schultzid, J.; Bernfeld, J.; Cullen, K.; Quan, N.G.; Kon, S.; Hotez, P.; Henao-Martínez, A.F.; Krsak, M. COVID-19 in jails and prisons: A neglected infection in a marginalized population. PLoS Negl. Trop. Dis. 2020, 14, 1–4. [CrossRef] [PubMed] 10. Castro, M.C.; Kim, S.; Barberia, L.; Ribeiro, A.F.; Gurzenda, S.; Ribeiro, K.B.; Abbott, E.; Blossom, J.; Rache, B.; Singer, B.H. Spatiotemporal pattern of COVID-19 spread in Brazil. Science 2021, 372, 821–826. [CrossRef] 11. Wadman, M. Blind spots thwart global coronavirus tracking. Science 2021, 372, 773–774. [CrossRef] 12. Wright, L.; Steptoe, A.; Fancourt, D. Are we all in this together? Longitudinal assessment of cumulative adversities by socioeconomic position in the first 3 weeks of lockdown in the UK. J. Epidemiol. Community Health 2020, 74, 683–688. [CrossRef] 13. Tipirneni, R. A Data-Informed Approach to Targeting Social Determinants of Health as the Root Causes of COVID-19 Disparities. Am. J. Public Health 2021, 111, 620–622. [CrossRef] [PubMed] 14. Pincus, T.; Esther, R.; DeWalt, D.A.; Callahan, L.F. Social conditions and self-management are more powerful determinants of health than access to care. Ann. Intern. Med. 1998, 129, 406–411. [CrossRef] [PubMed] 15. Sokka, T.; Kautiainen, H.; Pincus, T.; Toloza, S.; da Rocha Castelar Pinheiro, G.; Lazovskis, J.; Hetland, M.L.; Peets, T.; Immonen, K.; Maillefert, J.F.; et al. Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST-RA database. Ann. Rheum. Dis. 2009, 68, 1666–1672. [CrossRef] 16. Engel, G.L. The need for a new medical model: A challenge for biomedicine. Science 1977, 196, 129–136. [CrossRef] [PubMed] 17. Filc, D. The medical text: Between biomedicine and hegemony. Soc. Sci. Med. 2004, 59, 1275–1285. [CrossRef] [PubMed] 18. Upshaw, T.L.; Brown, C.; Smith, R.; Perri, M.; Ziegler, C.; Pinto, A.D. Social determinants of COVID-19 incidence and outcomes: A rapid review. PLoS ONE 2021, 16, e0248336. [CrossRef] 19. Eker, S. Validity and usefulness of COVID-19 models. Humanit. Soc. Sci. Commun. 2020, 7, 1–5. [CrossRef] 20. Galanis, G.; Hanieh, A. Incorporating Social Determinants of Health into Modelling of COVID-19 and other Infectious Diseases: A Baseline Socio-economic Compartmental Model. Soc. Sci. Med. 2021, 274, 113794. [CrossRef] 21. Leslie, D.; Mazumder, A.; Peppin, A.; Wolters, M.K.; Hagerty, A. Does “AI” stand for augmenting inequality in the era of COVID-19 healthcare? BMJ 2021, 372, n304. [CrossRef] [PubMed] 22. Whitehead, M. The concepts and principles of equity and health. Int. J. Health Serv. 1992, 22, 429–445. [CrossRef] [PubMed] 23. Diderichsen, F.; Hallqvist, J.; Whitehead, M. Differential vulnerability and susceptibility: How to make use of recent development in our understanding of mediation and interaction to tackle health inequalities. Int. J. Epidemiol. 2019, 48, 268–274. [CrossRef] 24. Fontanarosa, P.B.; Flanagin, A.; Ayanian, J.Z.; Bonow, R.O.; Bressler, N.M.; Christakis, D.; Disis, M.L.; Josephson, S.A.; Kibbe, M.R.; Öngür, D.; et al. Equity and the JAMA Network. JAMA Netw. Open 2021, 4, e2118381. [CrossRef] [PubMed] 25. Rivara, F.P.; Bradley, S.M.; Catenacci, D.V.; Desai, A.N.; Ganguli, I.; Haneuse, S.J.P.A.; Inouye, S.K.; Jacobs, E.A.; Kan, K.; Kim, H.S.; et al. Structural Racism and JAMA Network Open. JAMA Network Open 2021, 4, e2120269. [CrossRef] [PubMed] 26. O’Sullivan, T.L.; Phillips, K.P. From SARS to pandemic influenza: The framing of high-risk populations. Nat. Hazards 2019, 98, 103–117. [CrossRef] [PubMed] 27. Nicholls, S.G.; Newson, A.J.; Ashcroft, R.E. The need for ethics as well as evidence in evidence-based medicine. J. Clin. Epidemiol. 2016, 77, 7–10. [CrossRef] [PubMed] 28. O’Neill, J.; Tabish, H.; Welch, V.; Petticrew, M.; Pottie, K.; Clarke, M.; Evans, T.; Pardo Pardo, J.; Waters, E.; White, H.; et al. Applying an equity lens to interventions: Using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J. Clin. Epidemiol. 2014, 67, 56–64. [CrossRef] [PubMed] 29. Himmelstein, D.U.; Woolhandler, S. Health Insurance Status and Risk Factors for Poor Outcomes with COVID-19 among U.S. Health Care Workers: A Cross-Sectional Study. Ann. Intern. Med. 2020, 173, 410–412. [CrossRef] 30. Glover, R.E.; van Schalkwyk, M.C.I.; Akl, E.A.; Kristjannson, E.; Lotfi, T.; Petkovic, J.; Petticrew, M.P.; Pottie, K.; Tugwell, P.; Welch, V.; et al. A framework for identifying and mitigating the equity harms of COVID-19 policy interventions. J. Clin. Epidemiol. 2020, 128, 35–48. [CrossRef] 31. Tugwell, P.; Petticrew, M.; Kristjansson, E.; Welch, V.; Ueffing, E.; Waters, E.; Bonnefoy, J.; Morgan, A.; Doohan, E.; Kelly, M.P.; et al. Assessing equity in systematic reviews: Realising the recommendations of the Commission on Social Determinants of Health. BMJ 2010, 341, 873–877. [CrossRef] 32. Petticrew, M.; Roberts, H. Evidence, hierarchies, and typologies: Horses for courses. J. Epidemiol. Community Health 2003, 57, 527–529. [CrossRef] 33. Vasileiou, E.; Simpson, C.R.; Shi, T.; Kerr, S.; Agrawal, U.; Akbari, A.; Bedston, S.; Beggs, J.; Bradley, D.; Chuter, A.; et al. Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: A national prospective cohort study. Lancet 2021, 397, 1646–1657. [CrossRef] Int. J. Environ. Res. Public Health 2021, 18, 9357 11 of 12 34. Pan, K.Y.; Kok, A.A.L.; Eikelenboom, M.; Horsfall, M.; Jörg, F.; Luteijn, R.A.; Rhebergen, D.; Oppen, P.V.; Giltay, E.J.; Penninx, B.W.J.H. The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive- compulsive disorders: A longitudinal study of three Dutch case-control cohorts. Lancet Psychiatry 2021, 8, 121–129. [CrossRef] 35. Rizvi, A.; Wasfi, R.; Enns, A.; Kristjansson, E. The impact of novel and traditional food bank approaches on food insecurity: A longitudinal study in Ottawa, Canada. BMC Public Health 2021, 21, 771. [CrossRef] 36. Willows, N.D.; Veugelers, P.; Raine, K.; Kuhle, S. Prevalence and sociodemographic risk factors related to household food security in Aboriginal peoples in Canada. Public Health Nutr. 2009, 12, 1150–1156. [CrossRef] [PubMed] 37. Garber, K.; Fox, C.; Abdalla, M.; Tatem, A.; Qirbi, N.; Lloyd-Braff, L.; Al-Shabi, K.; Ongwae, K.; Dyson, M.; Hassen, K. Estimating access to health care in Yemen, a complex humanitarian emergency setting: A descriptive applied geospatial analysis. Lancet Glob. Health 2020, 8, e1435–e1443. [CrossRef] 38. Reporting Guidelines under Development for Observational Studies | The EQUATOR Network. Available online: https: //www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development- for-observational-studies/#STROBEeq (accessed on 10 June 2021). 39. Welch, V.; Rizvi, A. STROBE-Equity Reporting Guidelines. 2020. Available online: https://osf.io/h57se/ (accessed on 22 June 2021). 40. Glasziou, P.; Altman, D.G.; Bossuyt, P.; Boutron, I.; Clarke, M.; Julious, S.; Michie, S.; Moher, D.; Wager, E. Reducing waste from incomplete or unusable reports of biomedical research. Lancet 2014, 383, 267–276. [CrossRef] 41. Turner, L.; Shamseer, L.; Altman, D.G.; Schulz, K.F.; Moher, D. Does use of the CONSORT Statement impact the completeness of reporting of randomised controlled trials published in medical journals? A Cochrane review. Syst. Rev. 2012, 1, 1–7. [CrossRef] [PubMed] 42. Von Elm, E.; Altman, D.G.; Egger, M.; Pocock, S.J.; Gøtzsche, P.C.; Vandenbroucke, J.P. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLoS Med. 2007, 4, 1623–1627. [CrossRef] 43. General Assembly. United Nations. United Nations Declaration on the Rights of Indigenous Peoples A/RES/61/295. 2007. Avail- able online: https://www.un.org/development/desa/indigenouspeoples/declaration-on-the-rights-of-indigenous-peoples. html (accessed on 22 June 2021). 44. Truth and Reconciliation Commission of Canada. Truth and Reconciliation Commission of Canada: Calls to Action; Government of Canada: Winnipeg, MB, Canada, 2015. 45. Moher, D.; Schulz, K.F.; Simera, I.A.D. Guidance for Developers of Health Research Reporting Guidelines. PLoS Med. 2010, 7, e1000217. [CrossRef] [PubMed] 46. Jull, J.; Petticrew, M.; Kristjansson, E.; Yoganathan, M.; Petkovic, J.; Tugwell, P.; Welch, V.; CONSORT-Equity 2017 and Boston Equity Symposium participants. Engaging knowledge users in development of the CONSORT-equity 2017 reporting guideline: A qualitative study using indepth interviews. Res. Involv. Engagem. 2018, 4, 1–13. [CrossRef] [PubMed] 47. Welch, V.A.; Norheim, O.F.; Jull, J.; Cookson, R.; Sommerfelt, H.; Tugwell, P.; CONSORT-Equity and Boston Equity Symposium. CONSORT-Equity 2017 extension and elaboration for better reporting of health equity in randomised trials. BMJ 2017, 359, j5085. [CrossRef] [PubMed] 48. Heidari, S.; Babor, T.F.; De Castro, P.; Tort, S.; Curno, M. Sex and Gender Equity in Research: Rationale for the SAGER guidelines and recommended use. Res. Integr. Peer Rev. 2016, 1, 2. [CrossRef] [PubMed] 49. Welch, V.; Petticrew, M.; Tugwell, P.; Moher, D.; O’Neill, J.; Waters, E.; White, H. PRISMA-Equity 2012 Extension: Reporting Guidelines for Systematic Reviews with a Focus on Health Equity. PLoS Med. 2012, 9, e1001333. [CrossRef] 50. Epistemonikos Foundation. Methods for the Special L.OVE of Coronavirus Infection (COVID-19). Available online: https: //app.iloveevidence.com/covid19 (accessed on 15 June 2021). 51. Bilal, U.; Tabb, L.P.; Barber, S.; Diez Roux, A.V. Spatial Inequities in COVID-19 Testing, Positivity, Confirmed Cases, and Mortality in 3 U.S. Cities. Ann. Intern. Med. 2021, 174, 936–944. [CrossRef] [PubMed] 52. Zakeri, R.; Bendayan, R.; Ashworth, M.; Bean, D.M.; Dodhia, H.; Durbaba, S.; O’Gallagher, K.; Palmer, C.; Curcin, V.; Aitken, E.; et al. A case-control and cohort study to determine the relationship between ethnic background and severe COVID-19. EClinicalMedicine 2020, 28, 100574. [CrossRef] [PubMed] 53. Cattelan, A.M.; Sasset, L.; Di Meco, E.; Cocchio, S.; Barbaro, F.; Cavinato, S.; Gardin, S.; Carretta, G.; Donato, D.; Crisanti, A.; et al. An integrated strategy for the prevention of sars-cov-2 infection in healthcare workers: A prospective observational study. Int. J. Environ. Res. Public Health 2020, 17, 5785. [CrossRef] [PubMed] 54. Lazarus, J.V.; Wyka, K.; Rauh, L.; Rabin, K.; Ratzan, S.; Gostin, L.O.; Larson, H.J.; El-Mohandes, A. Hesitant or Not? The Association of Age, Gender, and Education with Potential Acceptance of a COVID-19 Vaccine: A Country-level Analysis. J. Health Commun. 2020, 25, 799–807. [CrossRef] 55. Sudre, C.H.; Murray, B.; Varsavsky, T.; Graham, M.S.; Penfold, R.S.; Bowyer, R.C.; Pujol, J.C.; Klaser, K.; Antonelli, M.; Canas, L.S. Attributes and predictors of long COVID. Nat. Med. 2021, 27, 626–631. [CrossRef] 56. Mekonnen, H.S.; Azagew, A.W.; Wubneh, C.A.; Belay, G.M.; Assimamaw, N.T.; Agegnehu, C.D.; Azale, T.; Azene, Z.N.; Merid, M.W.; Muluneh, A.G.; et al. Community’s misconception about COVID-19 and its associated factors among Gondar town residents, Northwest Ethiopia. Trop. Med. Health 2020, 48, 1–9. [CrossRef] Int. J. Environ. Res. Public Health 2021, 18, 9357 12 of 12 57. D’ambrosi, F.; Iurlaro, E.; Tassis, B.; Di Maso, M.; Erra, R.; Cetera, G.E.; Cesano, N.; Di Martino, D.; Ossola, M.W.; Ferrazzi, E.M. Sociodemographic characteristics of pregnant women tested positive for COVID-19 admitted to a referral center in Northern Italy during lockdown period. J. Obstet. Gynaecol. Res. 2021, 47, 1751–1756. [CrossRef] [PubMed] 58. Reyes-Vega, M.F.; Soto-Cabezas, M.G.; Cárdenas, F.; Martel, K.S.; Valle, A.; Valverde, J.; Vidal-Anzardo, M.; Falcón, M.E.; Munayco, C.V.; Peru COVID-19 Working Group. SARS-CoV-2 prevalence associated to low socioeconomic status and overcrowding in an LMIC megacity: A population-based seroepidemiological survey in Lima, Peru. EClinicalMedicine 2021, 34, 100801. [CrossRef] [PubMed] 59. Bajos, N.; Jusot, F.; Pailhé, A.; Spire, A.; Martin, C.; Meyer, L.; Lydié, N.; Franck, J.-E.; Zins, M. When lockdown policies amplify social inequalities in COVID-19 infections: Evidence from a cross-sectional population-based survey in France. BMC Public Health 2021, 21, 705. [CrossRef] [PubMed] 60. González-Rábago, Y.; Cabezas-Rodríguez, A.; Martín, U. Social inequalities in health determinants in spanish children during the COVID-19 lockdown. Int. J. Environ. Res. Public Health 2021, 18, 4087. [CrossRef] [PubMed] 61. Santos, V.S.; Souza Araújo, A.A.; de Oliveira, J.R.; Carrat, F. COVID-19 mortality among Indigenous people in Brazil: A nationwide register-based study. J. Public Health 2021, 43, e250–e251. [CrossRef] [PubMed] 62. Welch, V.; Tugwell, P.; Petticrew, M.; de Montigny, J.; Ueffing, E.; Kristjansson, B.; McGowan, J.; Benkhalti Jandu, M.; Wells, G.A.; Brand, K.; et al. How effects on health equity are assessed in systematic reviews of interventions. Cochrane Database Syst. Rev. 2010, 2010, MR000028. [CrossRef] 63. Abdalla, S.; Katz, E.G.; Darmstadt, G.L. Gender and the impact of COVID-19 on demand for and access to health care: Analysis of data from Kenya, Nigeria, and South Africa. Lancet Glob. Health 2021, 9, S7. [CrossRef] 64. Press, V.G.; Huisingh-Scheetz, M.; Arora, V.M. Inequities in Technology Contribute to Disparities in COVID-19 Vaccine Distribu- tion. JAMA Health Forum 2021, 2, e210264. [CrossRef] 65. Krieger, N.; Fee, E. Man-made medicine and women’s health: The biopolitics of sex/gender and race/ethnicity. Int. J. Health Serv. 1994, 24, 265–283. [CrossRef] 66. Browne, A.J.; Fiske, J.A. First nations women’s encounters with mainstream health care services. West. J. Nurs. Res. 2001, 23, 126–147. [CrossRef] [PubMed] 67. Crenshaw, K. Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Color. Stanf. Law Rev. 1991, 43, 1241. [CrossRef] 68. Van Herk, K.; Smith, D.; Andrew, C. Identity matters: Aboriginal mothers’ experiences of accessing care. Contemp. Nurse 2011, 37, 57–68. [CrossRef] [PubMed] 69. Morton Ninomiya, M.E.; Pollock, N.J. Reconciling community-based Indigenous research and academic practices: Knowing principles is not always enough. Soc. Sci. Med. 2017, 172, 28–36. [CrossRef] 70. Mashford-Pringle, A.; Pavagadhi, K. Using OCAP and IQ as frameworks to address a history of trauma in indigenous health research. AMA J. Ethics 2020, 22, E868–E873. [CrossRef] [PubMed] 71. Hankivsky, O.; Grace, D.; Hunting, G.; Giesbrecht, M.; Fridkin, A.; Rudrum, S.; Ferlatte, O.; Clark, N. An intersectionality-based policy analysis framework: Critical reflections on a methodology for advancing equity. Int. J. Equity Health 2014, 13, 1–16. [CrossRef] [PubMed] 72. Indigenous Community Research Partnerships Can Help Address Health Inequities. Available online: https://theconversation. com/indigenous-community-research-partnerships-can-help-address-health-inequities-152705 (accessed on 10 June 2021). 73. Hoeyer, K.; Bauer, S.; Pickersgill, M. Datafication and accountability in public health: Introduction to a special issue. Soc. Stud. Sci. 2019, 49, 459–475. [CrossRef] [PubMed] 74. Indigenous Research Training | Queen’s University. Available online: https://www.queensu.ca/indigenous/decolonizing-and- indigenizing/community-research-partnerships-training (accessed on 9 June 2021). 75. Staniszewska, S.; Brett, J.; Simera, I.; Seers, K.; Mockford, C.; Goodlad, S.; Altman, D.G.; Moher, D.; Barber, R.; Denegri, S.; et al. GRIPP2 reporting checklists: Tools to improve reporting of patient and public involvement in research. BMJ 2017, 358, 3453. [CrossRef] 76. Hill, R.; Walsh, F.J.; Davies, J.; Sparrow, A.; Mooney, M.; Central Land Council; Wise, R.M.; Tengö, M. Knowledge co-production for Indigenous adaptation pathways: Transform post-colonial articulation complexes to empower local decision-making. Glob. Environ. Chang. 2020, 65, 102161. [CrossRef] 77. Sugimoto, C.R.; Ahn, Y.Y.; Smith, E.; Macaluso, B.; Larivière, V. Factors affecting sex-related reporting in medical research: A cross-disciplinary bibliometric analysis. Lancet 2019, 393, 550–559. [CrossRef]