Evaluation of the Biases in the Studies that Assess the Effects of the Great Recession on Health. A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Systematic Review
2.2. Evaluation of Biases
3. Results
3.1. Systematic Review
3.2. Risk Assessment
3.3. Evaluation Problem
3.4. Time Bias
3.5. Other Biases
4. Discussion
5. Conclusions
Key points
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Data sharing statement
References
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Bias Domain 1 | Question to Consider | Indicator | Score (1: Low Risk of Bias; 2: Medium Risk; 3: High risk) |
---|---|---|---|
1. Confounding | Did the study analysis adjust potential confounders appropriately? | Confounders adjusted | 1: most confounders |
2: some confounders | |||
3: none or cannot tell | |||
2. Measurement error in health outcome | What was the heterogeneity of indicators used in the study? | Health outcome | 1: clinical indicator 2 |
2: self-reported validated tool | |||
3: self-reported tool but not clear if it had been validated 2 | |||
3. Measurement error in exposure variable | Did the study consider macroeconomic variables in the analysis? | Number of macroeconomic variables | 1: >1 variable |
2: 1 variable | |||
3: none | |||
4. Ecological fallacy | Were inferences about individuals deduced from inference for the group to which those individuals belonged? | Study design | 1: non-ecological |
3: ecological | |||
5. Time bias | Were there sufficiently long numbers of time periods in order to obtain reliable estimates? | Factors to be considered: >10 years of data; ≥3 years of data post crisis: potential lag effects | 1: 3 factors were considered |
2: ≥2 | |||
3: one or none | |||
6. Evaluation problem | Was an event (e.g., the Great Recession) evaluated using data in a different form from a cross section (e.g., health surveys) before and after that event? | Number of methods used to control bias | 1: >1 method |
2: 1 method | |||
3: none | |||
7. Unobserved confounding | Did the study control the heterogeneity (i.e., unobserved confounding) and temporal extra variability? | Number of methods used to control bias | 1: >1 method |
2: 1 method | |||
3: none | |||
Study Overall Rating | Strong (low risk of bias): none of the domains is rated as 3 | ||
Moderate: up to 2 domains were rated as 3 | |||
Weak (high risk of bias): ≥3 domains were rated as 3 |
Selection | Evaluation | Ecological Fallacy | Confounding | Unobserved Confounding | Time | Measurement Error | Number of 3 (High Risk) | Overall Rating | ||
---|---|---|---|---|---|---|---|---|---|---|
Exposure | Outcome | |||||||||
Mental Health | ||||||||||
Aguilar-Palacio, 2015 [6] | 1 | 3 | 1 | 2 | 3 | 3 | 2 | 2 | 3 | 3 |
Arroyo-Borrell, 2017 [7] | 1 | 2 | 1 | 1 | 1 | 3 | 3 | 2 | 2 | 2 |
Bacigalupe, 2016 [8] | 1 | 3 | 1 | 2 | 3 | 1 | 3 | 2 | 3 | 3 |
Barceló, 2016 [9] | 1 | 1 | 1 | 1 | 1 | 1 | 2 | 1 | 0 | 1 |
Bartoll, 2014 [10] | 1 | 3 | 1 | 2 | 3 | 3 | 3 | 2 | 4 | 3 |
Basterra, 2017 [11] | 1 | 3 | 1 | 2 | 3 | 3 | 3 | 2 | 4 | 3 |
Córdoba-Doña, 2016 [12] | 1 | 3 | 1 | 1 | 3 | 3 | 3 | 2 | 4 | 3 |
Fernández-García, 2018 [13] | 1 | 1 | 3 | 3 | 3 | 2 | 3 | 1 | 4 | 3 |
Gili, 2013 [14] | 1 | 2 | 1 | 2 | 3 | 3 | 1 | 2 | 2 | 2 |
Gili, 2014 [15] | 1 | 1 | 3 | 3 | 3 | 1 | 3 | 1 | 4 | 3 |
Gili, 2016 [16] | 1 | 3 | 1 | 2 | 3 | 3 | 1 | 2 | 3 | 3 |
Gotsens, 2015 [17] | 2 | 3 | 1 | 2 | 3 | 3 | 1 | 2 | 3 | 3 |
Iglesias-García, 2014 [18] | 2 | 1 | 1 | 3 | 3 | 1 | 2 | 2 | 2 | 2 |
Medel-Herreros, 2017 [19] | 1 | 1 | 3 | 3 | 3 | 1 | 3 | 1 | 4 | 3 |
Navarro-Mateu, 2015 [20] | 2 | 3 | 1 | 1 | 3 | 3 | 3 | 2 | 4 | 3 |
Pérez-Romero, 2016 [21] | 2 | 3 | 1 | 1 | 3 | 3 | 3 | 2 | 4 | 3 |
Rajmil, 2013 [22] | 1 | 3 | 1 | 2 | 3 | 3 | 2 | 2 | 3 | 3 |
Rajmil, 2015 [23] | 1 | 3 | 1 | 3 | 3 | 2 | 1 | 2 | 3 | 3 |
Robert, 2014 [24] | 3 | 3 | 1 | 1 | 3 | 3 | 3 | 2 | 5 | 3 |
Ruíz-Pérez, 2017 [25] | 1 | 2 | 3 | 1 | 1 | 3 | 1 | 2 | 2 | 2 |
Sicras-Mainar, 2015 [26] | 1 | 1 | 1 | 3 | 3 | 3 | 3 | 1 | 4 | 3 |
Utzet, 2016 [27] | 2 | 3 | 1 | 3 | 3 | 3 | 3 | 2 | 5 | 3 |
Zapata-Moya, 2015 [28] | 1 | 2 | 1 | 2 | 1 | 2 | 3 | 2 | 2 | 2 |
Self-Perceived Health | ||||||||||
Aguilar-Palacio, 2015 [5] | 1 | 3 | 1 | 2 | 3 | 3 | 2 | 2 | 3 | 3 |
Arroyo-Borrell, 2015 [29] | 1 | 1 | 1 | 1 | 1 | 3 | 3 | 2 | 2 | 2 |
Barroso, 2016 [30] | 2 | 3 | 1 | 1 | 3 | 3 | 3 | 2 | 4 | 3 |
Bartoll, 2015 [31] | 1 | 3 | 1 | 2 | 3 | 2 | 2 | 2 | 2 | 2 |
Calzón-Fernández, 2017 [32] | 2 | 3 | 1 | 1 | 3 | 3 | 3 | 2 | 3 | 3 |
Fornell, 2018 [33] | 1 | 2 | 1 | 2 | 1 | 2 | 3 | 2 | 2 | 2 |
Gotsens, 2015 [17] | 2 | 3 | 1 | 2 | 3 | 3 | 1 | 2 | 3 | 3 |
López-del-Amo, 2018 [34] | 1 | 2 | 1 | 1 | 1 | 3 | 1 | 2 | 1 | 2 |
Pérez-Romero, 2016 [21] | 2 | 2 | 1 | 1 | 3 | 3 | 3 | 2 | 3 | 3 |
Rajmil, 2013 [22] | 1 | 3 | 1 | 2 | 3 | 3 | 2 | 2 | 3 | 3 |
Rajmil, 2015 [23] | 1 | 2 | 1 | 3 | 3 | 2 | 1 | 2 | 2 | 2 |
Regidor, 2014 [35] | 1 | 3 | 3 | 3 | 3 | 1 | 3 | 1 | 4 | 3 |
Urbanos-Garrido, 2015 [36] | 1 | 1 | 1 | 1 | 3 | 3 | 3 | 2 | 3 | 3 |
Vásquez-Vera, 2016 [37] | 3 | 2 | 1 | 1 | 3 | 3 | 3 | 2 | 4 | 3 |
Zapata-Moya, 2015 [28] | 1 | 2 | 1 | 2 | 1 | 2 | 3 | 2 | 2 | 2 |
Suicides | ||||||||||
Álvarez-Gálvez, 2017 [38] | 1 | 1 | 3 | 2 | 3 | 1 | 1 | 1 | 2 | 2 |
Borrell, 2017 [39] | 1 | 1 | 3 | 2 | 3 | 1 | 3 | 1 | 3 | 3 |
Córdoba-Doña, 2014 [40] | 1 | 1 | 3 | 2 | 2 | 2 | 2 | 1 | 1 | 2 |
Gili, 2014 [15] | 1 | 1 | 3 | 3 | 3 | 1 | 3 | 1 | 4 | 3 |
López-Bernal, 2013 [41] | 2 | 1 | 3 | 2 | 2 | 3 | 3 | 1 | 3 | 3 |
Miret, 2014 [42] | 3 | 3 | 1 | 2 | 3 | 3 | 3 | 2 | 5 | 3 |
Rivera, 2016 [43] | 1 | 2 | 3 | 2 | 1 | 1 | 1 | 1 | 1 | 2 |
Ruíz-Pérez, 2017 [25] | 1 | 1 | 3 | 3 | 3 | 1 | 3 | 1 | 4 | 3 |
Saurina, 2015 [44] | 1 | 1 | 3 | 3 | 1 | 1 | 2 | 1 | 2 | 2 |
Mortality | ||||||||||
Alonso 2017 [45] | 1 | 1 | 1 | 3 | 3 | 2 | 3 | 1 | 3 | 3 |
Benmarhnia, 2014 [46] | 1 | 1 | 3 | 3 | 2 | 2 | 3 | 1 | 3 | 3 |
Ferrando, 2018 [47] | 1 | 1 | 3 | 3 | 1 | 2 | 3 | 1 | 3 | 3 |
Llàcer, 2014 [48] | 2 | 1 | 1 | 3 | 3 | 1 | 3 | 1 | 3 | 3 |
Maynou, 2016 [49] | 1 | 1 | 3 | 2 | 1 | 3 | 2 | 1 | 2 | 2 |
Regidor, 2014 [35] | 1 | 1 | 3 | 3 | 3 | 1 | 3 | 1 | 4 | 3 |
Regidor 2016 [50] | 1 | 1 | 1 | 3 | 3 | 2 | 3 | 1 | 3 | 3 |
Ruíz-Ramos, 2014 [51] | 1 | 1 | 3 | 3 | 2 | 2 | 3 | 1 | 3 | 3 |
Alcohol and Illegal Drugs | ||||||||||
Bosque-Prous, 2017 [52] | 1 | 3 | 1 | 1 | 3 | 3 | 3 | 2 | 4 | 3 |
Collell, 2015 [53] | 2 | 3 | 1 | 1 | 3 | 3 | 3 | 2 | 4 | 3 |
Gili, 2013 [14] | 1 | 2 | 1 | 2 | 3 | 3 | 1 | 2 | 2 | 2 |
Martín-Bassols, 2016 [54] | 2 | 3 | 1 | 1 | 2 | 3 | 2 | 2 | 2 | 2 |
Health Inequalities | ||||||||||
Abásolo, 2017 [55] | 1 | 2 | 1 | 1 | 1 | 3 | 3 | 2 | 2 | 2 |
Coveney, 2016 [56] | 1 | 1 | 1 | 1 | 2 | 1 | 3 | 2 | 1 | 2 |
Maynou, 2016 [49] | 1 | 1 | 3 | 2 | 1 | 3 | 2 | 1 | 2 | 2 |
Use of and Access to Health Services | ||||||||||
Abásolo, 2017 [55] | 1 | 2 | 1 | 1 | 1 | 3 | 3 | 2 | 2 | 2 |
Córdoba-Doña, 2018 [57] | 1 | 3 | 1 | 1 | 3 | 3 | 3 | 2 | 4 | 3 |
García-Subirats, 2014 [58] | 1 | 3 | 1 | 1 | 3 | 3 | 3 | 2 | 4 | 3 |
Lostao, 2017 [59] | 1 | 3 | 1 | 2 | 3 | 3 | 3 | 2 | 4 | 3 |
Other | ||||||||||
Calzón-Fernández, 2015 [60] | 1 | 3 | 1 | 1 | 3 | 3 | 3 | 2 | 4 | 3 |
Fernández, 2015 [61] | 3 | 1 | 1 | 1 | 3 | 3 | 3 | 2 | 4 | 3 |
Llàcer, 2014 [48] | 2 | 1 | 1 | 3 | 3 | 1 | 3 | 1 | 3 | 3 |
Larrañaga, 2014 [62] | 2 | 3 | 1 | 3 | 3 | 1 | 3 | 2 | 4 | 3 |
Lorenzo-Carrascosa,2016 [63] | 1 | 1 | 3 | 3 | 3 | 1 | 3 | 1 | 4 | 3 |
Palència, 2018 [64] | 1 | 1 | 1 | 2 | 1 | 2 | 3 | 1 | 1 | 2 |
Varea, 2016 [65] | 1 | 1 | 1 | 2 | 3 | 1 | 1 | 1 | 1 | 2 |
Health Outcome | Selection | Evaluation | Ecological Fallacy | Confounding | Unobserved Confounding | Time | Measurement Error Exposure | Measurement Error Outcome | Overall Rating | Total | |
---|---|---|---|---|---|---|---|---|---|---|---|
Mental health | n | 1 | 13 | 4 | 7 | 19 | 15 | 14 | 0 | 17 | 23 |
% | 4.3% | 56.5% | 17.4% | 30.4% | 82.6% | 65.2% | 60.9% | 0.0% | 73.9% | 32.4% | |
Self-perceived health | n | 1 | 7 | 1 | 2 | 11 | 10 | 8 | 0 | 9 | 14 |
% | 7.1% | 50.0% | 7.1% | 14.3% | 78.6% | 71.4% | 57.1% | 0.0% | 64.3% | 19.7% | |
Suicides | n | 1 | 1 | 8 | 3 | 5 | 2 | 5 | 0 | 5 | 9 |
% | 11.1% | 11.1% | 88.9% | 33.3% | 55.6% | 22.2% | 55.6% | 0.0% | 55.6% | 12.7% | |
Mortality | n | 0 | 0 | 5 | 7 | 4 | 1 | 7 | 0 | 7 | 8 |
% | 0.0% | 0.0% | 62.5% | 87.5% | 50.0% | 12.5% | 87.5% | 0.0% | 87.5% | 11.3% | |
Alcohol and illegal drugs | n | 0 | 3 | 0 | 0 | 3 | 4 | 2 | 0 | 2 | 4 |
% | 0.0% | 75.0% | 0.0% | 0.0% | 75.0% | 100.0% | 50.0% | 0.0% | 50.0% | 5.6% | |
Health inequalities | n | 0 | 0 | 1 | 0 | 0 | 2 | 2 | 0 | 0 | 3 |
% | 0.0% | 0.0% | 33.3% | 0.0% | 0.0% | 66.7% | 66.7% | 0.0% | 0.0% | 4.2% | |
Use and access of health services | n | 0 | 2 | 0 | 0 | 2 | 3 | 3 | 0 | 2 | 3 |
% | 0.0% | 66.7% | 0.0% | 0.0% | 66.7% | 100.0% | 100.0% | 0.0% | 66.7% | 4.2% | |
Other | n | 1 | 2 | 1 | 3 | 6 | 2 | 6 | 0 | 5 | 7 |
% | 14.3% | 28.6% | 14.3% | 42.9% | 85.7% | 28.6% | 85.7% | 0.0% | 71.4% | 9.9% | |
Total | n | 4 | 28 | 20 | 22 | 50 | 39 | 47 | 0 | 47 | 71 |
% | 5.6% | 39.4% | 28.2% | 31.0% | 70.4% | 54.9% | 66.2% | 0.0% | 66.2% | 100.0% |
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Saez, M.; Barceló, M.A.; Saurina, C.; Cabrera, A.; Daponte, A. Evaluation of the Biases in the Studies that Assess the Effects of the Great Recession on Health. A Systematic Review. Int. J. Environ. Res. Public Health 2019, 16, 2479. https://doi.org/10.3390/ijerph16142479
Saez M, Barceló MA, Saurina C, Cabrera A, Daponte A. Evaluation of the Biases in the Studies that Assess the Effects of the Great Recession on Health. A Systematic Review. International Journal of Environmental Research and Public Health. 2019; 16(14):2479. https://doi.org/10.3390/ijerph16142479
Chicago/Turabian StyleSaez, Marc, Maria Antònia Barceló, Carme Saurina, Andrés Cabrera, and Antonio Daponte. 2019. "Evaluation of the Biases in the Studies that Assess the Effects of the Great Recession on Health. A Systematic Review" International Journal of Environmental Research and Public Health 16, no. 14: 2479. https://doi.org/10.3390/ijerph16142479