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Is austerity responsible for the recent change in mortality trends across high-income nations? A protocol for an observational study
  1. Gerry McCartney1,
  2. Lynda Fenton1,2,
  3. Jon Minton1,
  4. Colin Fischbacher3,
  5. Martin Taulbut1,
  6. Kirsty Little4,
  7. Ciaran Humphreys4,
  8. Andrew Cumbers5,
  9. Frank Popham6,
  10. Robert McMaster5
  1. 1Public Health Observatory, NHS Health Scotland, Glasgow, Scotland, UK
  2. 2Public Health, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
  3. 3Information Services Division, NHS National Services Scotland, Edinburgh, Scotland, UK
  4. 4Public Health Wales, Cardiff, Wales, UK
  5. 5Adam Smith Business School, University of Glasgow, Glasgow, UK
  6. 6CSO/MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, UK
  1. Correspondence to Dr Gerry McCartney; gmccartney{at}


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.

  • international health services
  • epidemiology
  • public health
  • statistics & research methods

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  • Twitter @gerrymccartney1, @FentonLynda, @JonMinton

  • Contributors The planning of this work was undertaken by GM, LF, CF, KL and CH. The manuscript was drafted by GM and received important critical comments from LF, JM, CF, MT, KL, CH, AC, FP and RM. Statistical advice was received from JM and FP. Assistance with the background literature searches was received from LF, JM, MT and RM. The final draft was approved by all authors. The conduct and reporting of the research has not yet been undertaken as this is a protocol.

  • Funding The authors are salaried within NHS or the University of Glasgow. This work also forms part of a course of PhD study for GM which was part-funded by NHS Health Scotland.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval 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.

  • Provenance and peer review Not commissioned; externally peer reviewed.