Institute for Lifecourse Development, University of Greenwich, London, UK.
School of Health Sciences, University of Greenwich, London, UK.
Health Serv Res. 2022 Dec;57(6):1218-1234. doi: 10.1111/1475-6773.14022. Epub 2022 Jul 21.
This study sought to evaluate the impact of health care strike action on patient mortality.
EMBASE, PubMed CINAHL, BIOETHICSLINE, EconLit, WEB OF SCIENCE, and grey literature were searched up to December 2021.
A systematic review and meta-analysis were utilized.
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 with a control period where there was no strike action.
Seventeen studies examined mortality: 14 examined in-hospital mortality and three examined population mortality. In-hospital studies represented 768,918 admissions and 7191 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 versus non-strike periods (RR = 0.91, 95% confidence interval 0.63, 1.31, p = 0.598). Meta-regression also showed that mortality RR was not significantly impacted by country (p = 0.98), profession on strike (p = 0.32 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.
Based on the data available, this review did not find any evidence that strike action has any significant impact on in-hospital patient mortality.
本研究旨在评估医疗罢工行动对患者死亡率的影响。
截至 2021 年 12 月，检索了 EMBASE、PubMed CINAHL、BIOETHICSLINE、EconLit、WEB OF SCIENCE 和灰色文献。
系统评价和荟萃分析。
数据收集/提取：使用随机效应荟萃分析比较了罢工期间与罢工前或罢工后的死亡率，使用荟萃回归来确定可能影响罢工行动潜在影响的因素。如果研究是观察性研究，即在罢工期间与无罢工行动的对照期内比较住院/诊所或人群死亡率，则将其纳入研究。
有 17 项研究检查了死亡率：14 项研究检查了院内死亡率，3 项研究检查了人群死亡率。院内研究代表了罢工期间 768918 例住院和 7191 例死亡，以及对照期内 1034437 例住院和 12676 例死亡。与非罢工期间相比，罢工期间院内死亡率的合并相对风险（RR）没有显著差异（RR=0.91，95%置信区间 0.63，1.31，p=0.598）。荟萃回归还表明，死亡率 RR 不受国家（p=0.98）、罢工职业（多个职业 p=0.32，护士 p=0.80）、罢工持续时间（p=0.26）或多个机构是否罢工（p=0.55）的显著影响。仅有 3 项检查人群死亡率的研究符合纳入标准；因此，未进行进一步分析。然而，值得注意的是，这些研究均未报告罢工导致人群死亡率显著增加。
根据现有数据，本综述没有发现任何证据表明罢工行动对住院患者死亡率有任何显著影响。
