Advancing Health Equity in Europe: Explore, Tailor, Implement, and Evaluate ( ETIE )—A Framework of Diversity and Fairness in Pharmacoepidemiologic Research
Year: 2025
Type: review
Abstract: Pharmacoepidemiology should represent and benefit populations equitably, embracing diversity and equity, and ensuring fairness. This article describes equity and fairness in pharmacoepidemiology, depicts key diversity domains, and provides an operational framework and call for action to implement diversity and fairness in pharmacoepidemiologic research. To ensure fairness, studies should address diversity and inclusion while providing equal opportunities and benefits for everyone in the target population. To implement and evaluate fairness in pharmacoepidemiology, we defined the following diversity domains: biological sex, socially constructed gender, age, life stages (e.g., pregnancy, menopause), ethnicity, race, migration, nationality, socioeconomic status, education, health literacy, and health status and capabilities. These are determinants of health, either through biological pathways or through social norms, discrimination, and barriers to healthcare or research participation. They are interlinked, their impact is study- and context-specific, and due to their sensitive and evolving nature, they should be handled with caution. Implementing diversity domains enables researchers to assess the generalizability of findings, identify and address health inequities, account for determinants of health, and ensure the fairness of algorithms, implementations, and recommendations. To successfully implement diversity domains and ensure fair pharmacoepidemiologic research, we recommend researchers to follow the Explore, Tailor, Implement, and Evaluate (ETIE) framework: Explore the role/implication of the diversity domains in the study, tailor their definitions to the study context, implement them appropriately and evaluate the study findings in their context. Increased availability of diversity data is needed, and support from stakeholders is essential. This manuscript was endorsed by the International Society for Pharmacoepidemiology (ISPE).
DOI: 10.1002/pds.70175
Authors: Enriqueta Vallejo‐Yagüe, Sieta T. de Vries, Daniel La Parra‐Casado, Helga Gardarsdottir, Maria Luisa Faquetti, Irene van Valkengoed, Elodie Aubrun, Antonios Douros, Sandra Guedes, Adrian Martinez‐De La Torre, Jakob Wested, Taichi Ochi, Anne Marie Schumacher Dimech, Carole Clair, Isha Mehta, Fidelia Ida, Montse Soriano Gabarró, Oleksii Korzh, María Martínez‐González, Ariadna Maso, Diana Clamote Rodrigues, Jackie R. Ndem‐Galbert, Marta Korjagina, Swarnali Goswami, Daniela C. Moga, Andrea Fleisch Marcus, Hedvig Nordeng
Institutions: University of Bern, University Medical Center Groningen, University of Groningen, University of Alicante, University of Iceland, Utrecht University, University Medical Center Utrecht, ETH Zurich, Institute of Pharmaceutical Sciences, Amsterdam University Medical Centers, University of Amsterdam, Novartis (Switzerland), Charité – Universitätsmedizin Berlin, Ferring Pharmaceuticals (Denmark), University of Lucerne, Swiss Paraplegic Research, University of Copenhagen, Danish Medicines Agency, University of Lausanne, Regeneron (United States), CSL (United States), Bayer (Germany), Kharkiv National Medical University, Universidad Complutense de Madrid, Agencia Española de Medicamentos y Productos Sanitarios, European League Against Rheumatism, Neurocrine Biosciences (United States), University of Kentucky, Norwegian Institute of Public Health, University of Oslo
Language: English
Topic: Sex and Gender in Healthcare
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,650
OpenAlex ID: W4412505827