A quantitative assessment of the frequency and magnitude of heterogeneous treatment effects in studies of the health effects of social policies

Abstract

Substantial heterogeneity in effects of social policies on health across subgroups may be common, but has not been systematically characterized. Using a sample of 55 contemporary studies on health effects of social policies, we recorded how often heterogeneous treatment effects (HTEs) were assessed, for what subgroups (e.g., male, female), and the subgroup-specific effect estimates expressed as Standardized Mean Differences (SMDs). For each study, outcome, and dimension (e.g., gender), we fit a random-effects meta-analysis. We characterized the magnitude of heterogeneity in policy effects using the standard deviation of the subgroup-specific effect estimates (τ). Among the 44% of studies reporting subgroup-specific estimates, policy effects were generally small (<0.1 SMDs) with mixed impacts on health (67% beneficial) and disparities (50% implied narrowing of disparities). Across study-outcome-dimensions, 54% indicated any heterogeneity in effects, and 20% had τ > 0.1 SMDs. For 26% of study-outcome-dimensions, the magnitude of τ indicated that effects of opposite signs were plausible across subgroups. Heterogeneity was more common in policy effects not specified a priori. Our findings suggest social policies commonly have heterogeneous effects on health of different populations; these HTEs may substantially impact disparities. Studies of social policies and health should routinely evaluate HTEs.