Table 6 Quality of evidence
Domain | Quality rating | Comment |
|---|---|---|
Study design | Low | Study designs of included papers were observational and so precluded blinding and randomization to reduce the risk of bias. |
Risk of bias | High | Most information is taken from studies (included studies) at low risk of bias |
Consistency of results | Moderate | There was considerable heterogeneity among studies. However, the study explored the heterogeneity through sub-group analysis and meta-regressions |
Directness of evidence | Moderate | Most included papers analysed the direct effects of health shocks and ill health on affected individuals. However, some analysed spousal effects on women and husbands, thereby introducing some in directedness. |
Precision of results | High | The analysis had a large sample size comprising 117,656 individuals and consequently achieved narrow confidence intervals with a positive impact on precision. Additionally, most studies used nationally representative surveys allowing generalisation and applicability |
Publication bias | Moderate | Using the funnel plots, Egger’s test and Begg’s test, we did not evidence of publication bias |