A longitudinal analysis of published clinical practice guidelines and their effect on disease burden

Clinical practice guidelines (CPGs) are intended to improve health and reduce disease burden, yet their global status and their association with disease burden remain unknown. This longitudinal ecological study analyzes the quantity and quality of CPGs and explores their associations with disease burden. From 1995 to 2023, 10,657 CPGs were published, with the number of CPGs in 2023 being 5.15 times the number of CPGs in 1995. Europe contributed 40.2% of all CPGs, while CPGs from Africa accounted for only 0.8% of and showed minimal growth. Treatment CPGs contributed the most (45.0%), while diagnosis CPGs showed the fastest growth. Prevention CPGs (8.4%) and nursing CPGs (5.3%) and rehabilitation CPGs were less common, with rehabilitation CPGs showing the slowest growth. The 3-year update rate of CPG is 23.8%. Quality assessment of 1633 CPGs using AGREE II revealed substantial variation across domains. Overall 37.8% CPGs achieved scores above 70% per domain, while the “applicability” domain had the lowest median score (36%). Cross-region CPGs and CPGs for neoplasms exhibited the highest AGREE II scores, with the median score exceeding 70% in 3/6 domains. In contrast, CPGs from Asia and CPGs for cardiovascular diseases did not exceed the 70% threshold in any domain. Neither the quantity nor the quality of CPGs was significantly associated with disease burden at the national level. In conclusion, this study reveals that the quantity of CPGs has increased over the past three decades, although geographic and thematic differences remain. Future opportunities for CPG development include improving the AGREE II scores and focusing on less represented areas including rehabilitation, nursing and prevention. Here the authors perform a longitudinal analysis of the quantity and quality (determined by the AGREE II instrument) of clinical practice guidelines (CPGs) published between 1995 and 2023. They report that the overall volume of CPGs is increasing while the overall AGREE II scores remain below 70% for four out of six domains, but both the quantity and quality are dependent on geographic location and indication. Neither the quantity nor the quality of CPGs is associated with national disease burden.