Systematic reviews of observational studies frequently conclude based on meta-analyses of biased results: Standards must be improved.

Background: Systematic reviews of observational studies are common, yet the methodology of these systematic reviews and meta-analyses based on observational data are not standardized.

Methods: We reviewed systematic reviews including observational studies published in JAMA, Lancet, BMJ or Annals of Internal Medicine journals in 2024. We extracted information on the methodology and reporting of these reviews. We propose minimal standards for conduct and reporting of systematic reviews including observational studies.

Results: We included 63 systematic reviews that compiled observational studies. Nearly all (51/63, 80.9%) performed meta-analyses of crude, unadjusted, results from observational studies. Only 22/63 (34.9%) addressed anywhere in the article or supplement adjusted association estimates from observational studies. Adjusted and unadjusted meta-analyses were presented in 9/63 (14.3%) reviews. The study designs included in the review were not presented in the abstract or in the methods section in about a third of the reviews. These systematic reviews frequently concluded strongly on effects that cannot be assessed in observational data. We analysed the methodology used in the systematic reviews addressing adjusted results from observational studies and propose standards for analysis and reporting of systematic reviews of observational studies.

Conclusions: Use of crude data is common in systematic reviews including observational studies and ignores bias by indication, immortal time bias and other biases. These reviews are misleading and better standards are needed.