To identify how social determinants of health are reported in the current evidence base of randomised controlled trials (RCTs) of non-surgical interventions for treating pelvic organ prolapse (POP).

This was a secondary analysis of a systematic review and component network meta-analysis (CNMA), which was preregistered on PROPSERO (CRD42024595871). The protocol for the secondary analysis was published on the OSF. The Cochrane Incontinence Specialised Register, which includes RCTs and quasi-RCTs from MEDLINE, CINAHL, Embase and CENTRAL, and clinical trial registries, was searched from inception to 31 March 2023. The search strategies maintaining the Specialised Register were applied to each database and registry up to 24 April 2025. Iterative reference list and citation checking were also undertaken. Eligibility criteria for the review and secondary analysis included RCTs and quasi-RCTs of women with POP assessing the effects of non-surgical interventions compared with no treatment, usual care, another non-surgical intervention, or surgery. 

Study selection and data extraction were both undertaken using gold standard methods outlined by the Cochrane Handbook (1). Two independent reviewers undertook data extraction using a pre-piloted form. To assess how social determinants of health were reported, we extracted information from each included study using the PROGRESS-Plus framework (2,3), which includes the following factors that may contribute to health inequalities: place of residence; ethnicity/race/culture/language; occupation; gender/sex; religion; education; socioeconomic status; social capital; personal characteristics (e.g. age, comorbidities); time-dependent factors; and features of relationships (e.g. family history of POP). Data on the number of studies that presented inclusion criteria, exclusion criteria or demographic information relating to each PROGRESS-Plus variable were tabulated. As the importance of individual factors varied by context, we subgrouped results by whether they were conducted in high-income countries (HICs) or low-or-middle-income countries (LMICs) according to the World Bank.

In total, 53 RCTs were included. Reporting of demographic details linked to PROGRESS-Plus factors was very limited (Figure 2). All but three studies reported participants’ age but other personal characteristics, such as parity, comorbidities and menopausal status, were reported by less than half of the 53 included studies. Place of residence, race/ethnicity/culture/language, occupation, socioeconomic status, social capital and features of relationships were reported in less than 20% of included studies. Baseline characteristics surrounding place of residence, ethnicity/race/culture/language, occupation, socioeconomic status, social capital and features of relationships were reported in less than 20% of the included studies. No included studies reported any information surrounding gender/sex, religion, sexual orientation or time-dependent relationships. 

Some trials excluded women with comorbidities or additional health needs, including mental or psychiatric conditions (N=9), cognitive disorders (N=1), detrusor overactivity (N=2), reduced cystometric capacity (N=1), and radiating back pain (N=1) (Figure 2). In several cases, the rationale for these exclusions was not explicitly reported. There was little difference in level of reporting between studies conducted in HICs and LMICs, though place of residence and socioeconomic status were only reported in studies from LMICs.

Some eligibility criteria within published RCTs may be erroneously excluding women who could feasibly take part in clinical trials for POP. Reporting of social determinants of health that may influence health inequalities is generally poor. This means our current ability to understand who was involved in these trials and whether they are representative of the broader population of women with POP is limited.

There is currently inadequate reporting of social determinants of health within RCTs assessing non-surgical treatments for POP. Baseline variables for participants according to PROGRESS-Plus domains should be reported in future studies. Future studies should also consider an intersectional perspective to examine interacting influences of multiple variables that may contribute to health inequalities.

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions version 6.5 (updated August 2024). Cochrane, 2024. Available from www.cochrane.org/handbook.
O'Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. Journal of Clinical Epidemiology. 2014;67(1):56 – 64.
Cochrane Methods Equity. PROGRESS-Plus 2014 [Available from: https://methods.cochrane.org/equity/projects/evidence-equity/progress-plus].