Prevalence studies inform understanding of an individual's baseline risk for a medical or health condition as well as the burden of the disease and the characteristics of a given target population. Meanwhile, estimates of the the absolute risk, taken from prevalence data, informs the development of evidence-based guidelines. But how can one tell if the data on prevalence are trustworthy or seriously biased?
There currently exists no widely agreed-upon tool to assess the risk of bias within studies of prevalence analogous to the Cochrane RoB 2.0 tool for randomized controlled trials or QUADAS-2 for studies of diagnostic test accuracy. Additionally, the assessment of a prevalence study comes with its own challenges, as it requires assessment of population selection, condition treatment, and analysis.
Dr. Ali Choaib, a post-doctoral research fellow in the Evidence-based Practice and Impact Center at the University of Kansas Medical Center, discussed this gap and his proposed project to address it as part of his presentation as the spring 2025 Evidence Foundation scholarship recipient.
At the GRADE Guideline Development Workshop held in Arlington, Virginia, last month, Dr. Choaib presented his work in systematically reviewing and thematically analyzing all existing tools to assess risk of bias in prevalence studies. Choaib and his team identified four major conceptual domains shared across the existing tools: study population, sampling, and setting; case/condition definition and measurement; statistical analysis; and other (e.g., conflicts of interest and missing data).
Next, Choaib's team will work to develop and receive iterative feedback on a new tool that assesses all critical domains while taking care not to include items or questions that are not specifically related to bias, such as those assessing reporting quality.
About his experience of the workshop, Choaib said,
"The workshop was a perfect opportunity to learn, network, and collaborate with experts. Topics were dynamic and sessions tailored to individuals at all stages of the guideline development process from researchers to admins. I’m honored to have received the scholarship and to have contributed to discussions that expanded my knowledge and understanding of the guideline development process overall and with regards to diagnostic test accuracy specifically."
Choaib has additionally received the Encoding Health Equity Summit 2025 Travel Scholarship Program for Patients and Emerging Leaders. This scholarship, which is made possible with support from the Doris Duke Foundation, the Council of Medical Specialty Societies (CMSS), allowed him to attend the 2025 Encoding Health Equity Summit. This year's theme was "From Evidence to Impact."
"Encoding Health Equity Summit was an eye opening and career influencing experience. Being a scholar and having the opportunity to contribute to the discussion on a novel and noble approach to health equity at a time when it’s needed. The meeting introduced us to other other investigators, administrators, journal editors, and society leaders broadened my perspective and opening the way for new opportunities and collaboration. This meeting has also connected ideas and work from basic science to implementation. It was inspiring to see so many passionate professionals working to advance equity and improve the future of health."
Interested in contributing to the future of evidence-based medicine? Become an Evidence Foundation Scholar and attend our upcoming virtual fall workshop (October 29-31, 2025) for free. Application close August 31, 2025. See evidencefoundation.org/scholarships.html for application details.
Learn more about Ali's project and other ways to get involved with GRADE at our upcoming free webinar, Monday, November 17th. Register to attend at this link.
