Essex, Ryan ORCID: https://orcid.org/0000-0003-3497-3137, Weldon, Sharon Marie ORCID: https://orcid.org/0000-0001-5487-5265, Kalocsanyiova, Erika ORCID: https://orcid.org/0000-0002-3535-1084, Mccrone, Paul ORCID: https://orcid.org/0000-0001-7001-4502 and Deb, Sanjoy (2022) The impact of healthcare strikes on patient mortality: a systematic review and meta-analysis of observational studies. Health Services Research, 57 (6). pp. 1218-1234. ISSN 0017-9124 (Print), 1475-6773 (Online) (doi:10.1111/1475-6773.14022)

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Abstract

Objective
This study sough to evaluate the impact of healthcare strike action on patient mortality.
Data sources
EMBASE, PubMed CINAHL, BIOETHICSLINE, EconLit, WEB OF SCIENCE and Grey literature were searched up to December 2021.
Study design
A systematic review and meta-analysis was utilised.
Data collection/extraction
Random-effects meta-analysis was used to compare mortality rate during-strike versus pre or post strike, with meta-regression employed to identify factors that might influence the potential impact of strike action. Studies were included if they were observational studies that examined in-hospital/clinic or population mortality during a strike period compared to a control period where there was no strike action.
Principal findings
Seventeen studies examined mortality; 14 examined in-hospital mortality, three examined population mortality. In-hospital studies represented 768,918 admissions and 7,191 deaths during strike action and 1,034,437 admissions and 12,676 deaths during control periods. The pooled relative risk (RR) of in-hospital mortality did not significantly differ during strike action vs. non-strike periods (RR = 0.91, 95% CI [0.63, 1.31], p = .598). Meta-regression also showed that mortality RR was not significantly impacted by country (p = 0.98), profession on strike (p = .32 for multiple professions, p = 0.80 for nurses),the duration of the strike (p = 0.26) or whether multiple facilities were on strike (p = 0.55). Only three studies that examined population mortality met the inclusion criteria, therefore further analysis was not conducted. However it is noteworthy that none of these studies reported a significant increase in population mortality attributable to strike action.
Conclusions
Based on the data available, this review did not find any evidence that strike action has any significant impact on in-hospital patient mortality.

Item Type:	Article
Uncontrolled Keywords:	strike; protest; mortality; health systems; health policy; healthcare worker
Subjects:	H Social Sciences > HV Social pathology. Social and public welfare R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Chronic Illness and Ageing Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Professional Workforce Development
Last Modified:	07 Dec 2022 13:35
URI:	http://gala.gre.ac.uk/id/eprint/36580

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