Abstract：
This article systematically reviews evidence evaluating whether macroeconomic austerity policies impact mortality, reviewing high-income country data compiled through systematic searches of nine databases and gray literature using pre-specified methods (PROSPERO registration: CRD42020226609). Eligible studies were quantitatively assessed to determine austerity\'s impact on mortality. Two reviewers independently assessed eligibility and risk of bias using ROBINS-I. Synthesis without meta-analysis was conducted due to heterogeneity. Certainty of evidence was assessed using the GRADE framework. Of 5,720 studies screened, seven were included, with harmful effects of austerity policies demonstrated in six, and no effect in one. Consistent harmful impacts of austerity were demonstrated for all-cause mortality, life expectancy, and cause-specific mortality across studies and different austerity measures. Excess mortality was higher in countries with greater exposure to austerity. Certainty of evidence was low. Risk of bias was moderate to critical. A typical austerity dose was associated with 74,090 [-40,632, 188,792] and 115,385 [26,324, 204,446] additional deaths per year. Austerity policies are consistently associated with adverse mortality outcomes, but the magnitude of this effect remains uncertain and may depend on how austerity is implemented (e.g., balance between public spending reductions or tax rises, and distributional consequences). Policymakers should be aware of potential harmful health effects of austerity policies.
摘要：
本文系统地回顾了评估宏观经济紧缩政策是否影响死亡率的证据，使用预先指定的方法（PROSPERO注册：CRD42020226609），通过系统搜索9个数据库和灰色文献来审查高收入国家的数据。对符合条件的研究进行了定量评估，以确定紧缩对死亡率的影响。两名评审员使用ROBINS-I独立评估资格和偏见风险。由于异质性，进行了没有荟萃分析的合成。使用等级框架评估证据的确定性。在筛选的5720项研究中，包括七个，紧缩政策的有害影响表现在六个方面，一个没有效果。紧缩对全因死亡率的持续有害影响得到了证明，预期寿命,以及不同研究和不同紧缩措施的特定原因死亡率。在紧缩风险较大的国家，超额死亡率较高。证据的确定性很低。偏倚的风险是中等到严重的。典型的紧缩剂量每年与74,090[-40,632,188,792]和115,385[26,324,204,446]额外死亡相关。紧缩政策始终与不利的死亡率结果相关，但这种影响的程度仍然不确定，可能取决于紧缩政策的实施方式(例如，公共支出削减或税收增加之间的平衡，和分配后果)。政策制定者应该意识到紧缩政策对健康的潜在有害影响。
