The PROGRESSplus framework (education, gender, occupation, place of residence, race/ethnicity, religion, socioeconomic status, and social capital - PLUS age, disability, and sexual orientation) is a framework that narrowly focuses on dimensions of health inequality/inequity but rarely takes into account the pathways and interactions of these dimensions and their impact on outcomes [1].

The term PROGRESS refers to factors that are thought to affect health disparities or opportunities. First operationalized in 2003, it was designed to identify characteristics distinguishing health opportunities and outcomes, after studying traffic accidents in underdeveloped nations. It was later approved and improved upon in 2008 to include other individual characteristics (age, disability, and sexual orientation) that might be used to identify disadvantaged demographic segments. Fifty (50) systematic reviews examined differential effects of interventions across PROGRESS or PROGRESS-Plus features. The most common factors assessed in the reviews were SES (50/62), race/ethnicity (46/62), occupation (40/62), and gender/sex (41/62) [1].

The characteristics of the PROGRESSplus framework methodological guide is presented below:

• Age
• Disability
• Education
• Gender
• Occupation
• Place of residence
• Race/ethnicity
• Religion
• Sexual orientation
• Socioeconomic status
• Social capital

There exists a correlation between the PROGRESS/Plus framework and the PRISMA-Equity checklist. First, both guidance documents were developed using a consensus methodology by the Campbell and Cochrane Equity Methods Group and there is therefore some overlap in authorship. Also, while the main purpose of the PROGRESS/Plus framework is to identify individual characteristics that may contribute to health inequality or inequity, the PRISMA-Equity checklist is a document recommending ways to improve transparency and reporting standards of equity-focused reviews [1].

As such, the PROGRESS-Plus framework is embedded within one of the categories of the PRISMAEquity checklist (item 11), where reviewers are required to record the variables related to equity that were identified. However, empirical studies were conducted to evaluate the validity PROGRESS-Plus framework’s recommendations and the PRISMA-Equity checklist against the experiences and practices of subject experts. In both cases, the majority of experts concluded that the tools were a useful reminder of the items to consider in equity-focused reviewsincluding the conduct, reporting, and use of research [1].

Although PROGRESS-plus factors are an essential component in analyzing differential effects of interventions in health outcomes, it can be argued that the framework is limited in the sense that it is simply a list of characteristics defining the dimensions of health inequality/inequity. It is also important to note that using the framework does not necessarily mean that a review is assessing the equity impact of an intervention. In some cases, PROGRESS-plus factors are used as subgroup supplementary analyses to quantify the extent to which they affect outcomes. However, these subgroup analyses may not always show the causal pathway or how these factors interact with each other or how they can influence inequalities or inequities in later life [1].

In some cases, PROGRESS-plus factors are used as subgroup supplementary analyses to quantify the extent to which they affect outcomes. However, these subgroup analyses may not always show the causal pathway or how these factors interact with each other or how these factors can influence inequalities or inequities in later life [1].

• A systematic review finds a lack of consensus in methodological approaches in health inequality/inequity focused reviews

[1] Kunonga TP, Hanratty B, Bower P, Craig D. A systematic review finds a lack of consensus in methodological approaches in health inequality/inequity focused reviews. Journal of Clinical Epidemiology. 2023 Feb 20.