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Meta-Analysis
. 2022 Dec;57(6):1218-1234.
doi: 10.1111/1475-6773.14022. Epub 2022 Jul 21.

The impact of health care strikes on patient mortality: A systematic review and meta-analysis of observational studies

Ryan Essex  1 , Sharon Marie Weldon  1   2   3   4 , Trevor Thompson  5 , Erika Kalocsányiová  1 , Paul McCrone  1   2 , Sanjoy Deb  6
Affiliations
Meta-Analysis

The impact of health care strikes on patient mortality: A systematic review and meta-analysis of observational studies

Ryan Essex et al. Health Serv Res. 2022 Dec.

Abstract

Objective: This study sought to evaluate the impact of health care 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 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.

Principal findings: 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.

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.

Keywords: health care worker; health policy; health systems; mortality; protest; strike.

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Figures

FIGURE 1
FIGURE 1
PRISMA 2020 flow diagram [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Forest plot of risk‐ratios on the impact of strike action on in‐hospital mortality
See this image and copyright information in PMC

References

    1. Gopalan A. Massachusetts nurses just won an epic 10‐month strike. The New Republic, 2022.
    1. Slater PE, Modan B, Greenberg DS. Doctors' strike in Israel. N Engl J Med. 1984;310(10):660‐661. - PubMed
    1. Riaz M, Bhaumik S. Police target doctors over strike action in Pakistan. Lancet. 2012;380(9837):97. - PubMed
    1. Halperin EC. “We Do Not Want Him Because He Is a Jew”: the Montreal Interns' Strike of 1934. Ann Intern Med. 2021;174(6):852‐857. - PubMed
    1. Essex R, Weldon S. The justification for strike action in healthcare: a systematic critical interpretive synthesis. Nurs Ethics. 2022:09697330211022411. - PMC - PubMed