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

Ryan Essex; Sharon Marie Weldon; Trevor Thompson; Erika Kalocsányiová; Paul McCrone; Sanjoy Deb

doi:10.1111/1475-6773.14022

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

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

Authors

Ryan Essex¹, Sharon Marie Weldon^{1

2

3

4}, Trevor Thompson⁵, Erika Kalocsányiová¹, Paul McCrone^{1

2}, Sanjoy Deb⁶

Affiliations

¹ Institute for Lifecourse Development, University of Greenwich, London, UK.
² School of Health Sciences, University of Greenwich, London, UK.
³ Barts Health NHS Trust, The Royal Hospital, London, UK.
⁴ Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London, UK.
⁵ School of Human Sciences, University of Greenwich, London, UK.
⁶ School of Life Sciences, University of Westminster, London, UK.

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.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Delivery of Health Care
Health Facilities*
Hospital Mortality
Hospitalization*
Humans