Is austerity responsible for the recent change in mortality trends across high-income nations? A protocol for an observational study

McCartney, G. , Fenton, L., Minton, J. , Fischbacher, C., Taulbut, M., Little, K., Humphreys, C., Cumbers, A. , Popham, F. and McMaster, R. (2020) Is austerity responsible for the recent change in mortality trends across high-income nations? A protocol for an observational study. BMJ Open, 10(1), e034832. (doi: 10.1136/bmjopen-2019-034832) (PMID:31980513) (PMCID:PMC7044814)

Abstract

Introduction: Mortality rates in many high-income countries have changed from their long-term trends since around 2011. This paper sets out a protocol for testing the extent to which economic austerity can explain the variance in recent mortality trends across high-income countries. Methods and analysis: This is an ecological natural experiment study, which will use regression adjustment to account for differences in exposure, outcomes and confounding. All high-income countries with available data will be included in the sample. The timing of any changes in the trends for four measures of austerity (the Alesina-Ardagna Fiscal Index, real per capita government expenditure, public social spending and the cyclically adjusted primary balance) will be identified and the cumulative difference in exposure to these measures thereafter will be calculated. These will be regressed against the difference in the mean annual change in life expectancy, mortality rates and lifespan variation compared with the previous trends, with an initial lag of 2 years after the identified change point in the exposure measure. The role of underemployment and individual incomes as outcomes in their own right and as mediating any relationship between austerity and mortality will also be considered. Sensitivity analyses varying the lag period to 0 and 5 years, and adjusting for recession, will be undertaken. Ethics and dissemination: All of the data used for this study are publicly available, aggregated datasets with no individuals identifiable. There is, therefore, no requirement for ethical committee approval for the study. The study will be lodged within the National Health Service research governance system. All results of the study will be published following sharing with partner agencies. No new datasets will be created as part of this work for deposition or curation.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cumbers, Professor Andrew and McMaster, Professor Robert and Minton, Dr Jonathan and Popham, Dr Frank and McCartney, Professor Gerard
• Authors: McCartney, G., Fenton, L., Minton, J., Fischbacher, C., Taulbut, M., Little, K., Humphreys, C., Cumbers, A., Popham, F., and McMaster, R.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU; College of Social Sciences > Adam Smith Business School > Management; College of Social Sciences > School of Social and Political Sciences; College of Social Sciences > School of Social and Political Sciences > Sociology Anthropology and Applied Social Sciences
• Journal Name: BMJ Open
• Publisher: BMJ Publishing Group
• ISSN: 2044-6055
• ISSN (Online): 2044-6055
• Published Online: 23 January 2020
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in BMJ Open 10(1): e034832
• Publisher Policy: Reproduced under a Creative Commons License