为了评估非癌症疾病中过度诊断的证据强度和程度。我们系统地检索了调查非癌症疾病中过度诊断的研究。使用“公平裁判”框架来评估通过一种诊断策略而不是另一种诊断策略诊断的病例可能被过度诊断的证据，两名评审员独立确定了公平裁判——特定疾病的临床结果、测试结果或风险因素是否可以确定是否存在其他病例是否患有疾病。疾病特异性临床结果为过度诊断提供了最有力的证据，随访或同时检测提供了较弱的证据，而危险因素仅提供了较弱的证据。没有公平裁判的研究提供了过度诊断的最弱证据。在 132 项研究中，47 项 (36%) 没有包括公平裁判来裁定额外的诊断。当存在时，最常见的裁判员是单一测试或危险因素（32% 的研究），只有 21% 的研究使用特定疾病临床结果的裁判员。过度诊断的估计包括 43%-45% 的筛查发现的急性腹动脉瘤、54% 的急性肾损伤病例和 77% 的妊娠期羊水过少病例。目前关于非癌症疾病过度诊断的大部分证据都很薄弱。该框架的应用可以指导开展稳健的研究，以检测和估计非癌症疾病的过度诊断，最终为减少过度诊断的循证政策提供信息。版权所有 © 2023 作者。由爱思唯尔公司出版。保留所有权利。

To evaluate the strength of the evidence for, and the extent of, overdiagnosis in non-cancer conditions.We systematically searched for studies investigating overdiagnosis in non-cancer conditions. Using the 'Fair Umpire' framework to assess the evidence that cases diagnosed by one diagnostic strategy but not by another may be overdiagnosed, two reviewers independently identified whether a Fair Umpire - a disease-specific clinical outcome, a test result or risk factor that can determine whether an additional case does or does not have disease - was present. Disease-specific clinical outcomes provide the strongest evidence for overdiagnosis, follow-up or concurrent tests provide weaker evidence and risk factors provide only weak evidence. Studies without a Fair Umpire provide the weakest evidence of overdiagnosis.Of 132 studies, 47 (36%) did not include a Fair Umpire to adjudicate additional diagnoses. When present, the most common Umpire was a single test or risk factor (32% of studies), with disease-specific clinical outcome Umpires used in only 21% of studies. Estimates of overdiagnosis included 43%-45% of screen-detected acute abdominal aneurysms, 54% of cases of acute kidney injury and 77% of cases of oligohydramnios in pregnancy.Much of the current evidence for overdiagnosis in non-cancer conditions is weak. Application of the framework can guide development of robust studies to detect and estimate overdiagnosis in non-cancer conditions, ultimately informing evidence-based policies to reduce it.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.