Impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course: A systematic review

Abstract

ObjectivesDisasters, such as the current COVID-19 pandemic, disrupt daily life, increase uncertainty and stress, and may increase long-term risk of adverse cardiometabolic outcomes, including heart disease, obesity and diabetes. The objective was to conduct a systematic review to determine the impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course.DesignA systematic search was conducted in May 2020 using two electronic databases, EMBASE and Medline. All studies were screened in duplicate at title and abstract, and full-text level. Studies were eligible for inclusion if they assessed an association with population-level or community disaster and cardiometabolic outcomes. There were no restrictions on year of publication, country or population. Non-English and earthquake-related studies were excluded. Data were extracted on study characteristics, exposure (e.g., type of disaster, name of specific event, region, year), cardiometabolic outcomes, and measures of effect. Study quality was evaluated using the Joanna Briggs Institute critical appraisal tools.ResultsA total of 58 studies were included, with 24 studies reporting the effects of exposure to disaster during pregnancy/childhood and 34 studies reporting the effects of exposure during adulthood. Studies included exposure to natural (60%) and human-made (40%) disasters, with only 3 (5%) of these studies evaluating previous pandemics. Most studies were conducted in North America (62%). Most studies reported increased cardiometabolic risk, including increased cardiovascular disease incidence or mortality, diabetes, and obesity. Few studies investigated potential mechanisms or identified high risk subgroups.ConclusionsUnderstanding the long-term consequences of disasters on cardiometabolic outcomes across the life-course may inform public health strategies for the current COVID-19 pandemic. This review found strong evidence of an increased association between disaster exposure and cardiometabolic outcomes across the life-course, although more research is needed to better understand the mechanisms and preventative efforts.PROSPERO registrationCRD – 42020186074Strengths and limitations of this studyThis systematic review is one of the first to review the literature on disasters, including pandemics, and subsequent cardiometabolic outcomes throughout the life-course.A comprehensive search strategy was developed in consultation with Health Science Librarians at McMaster University, which resulted in 58 studies that were eligible for inclusion into the review.Due to the heterogeneity of the included studies, a meta-analysis was not conducted.This review contributes a synthesis of the literature on the impact of disasters and cardiometabolic outcomes, that can help to inform public health strategies for the current COVID-19 pandemic.

Stressors and perceived consequences of the COVID-19 pandemic among older adults: a cross-sectional study using data from the Canadian Longitudinal Study on Aging

“… 8 , 10 Previous research on population-level disasters, including earthquakes and floods, has found that exposure to stress during an acute disaster has a profound impact on long-term health outcomes, including chronic diseases. 11 …”

“…8,10 Previous research on population-level disasters, including earthquakes and floods, has found that exposure to stress during an acute disaster has a profound impact on longterm health outcomes, including chronic diseases. 11 Given the dramatic change in daily functioning during the COVID-19 pandemic, several factors (e.g., limited access to physical activity facilities, closures) may contribute to increased incidence of obesity, cardiovascular disease and type 2 diabetes; however, it has been hypothesized that chronic stress, in particular, may influence disease development. 12…”

A life course epidemiology approach to climate extremes and human health

“…6 Most literature on climate change-related exposures and health focuses on acute or short-term effects. 7,8 Incorporating an LCE approach into climate and health research would expand this literature to understand the latent effects of early-life exposures over the entire life course. An LCE-CEHH approach will focus attention on the acute health effects of climate change-related exposures that occur at all ages, as well as the delayed effects of single or cumulative climate exposures.…”

Changes in Alcohol Consumption, Eating Behaviors, and Body Weight during Quarantine Measures: Analysis of the CoCo-Fakt Study

“…The extent to which these behaviors further promote increased rates of noncommunicable diseases, especially cardiometabolic diseases, and their associated mortality as well as psychiatric manifestations, even after the pandemic, cannot yet be determined. Drawing on analyses of previous disasters and pandemics, De Rubeis et al [7] and Muehlschlegel et al [8] have suggested that they may lead to behavioral changes, such as negative changes in physical activity, sleep, and diet, as well as increased alcohol consumption and intoxication as a consequence of stress exposure and lack of access to health services (among other factors), thus contributing to an increased incidence of noncommunicable diseases over the life course. So far, research focused on the consequences of voluntary self-quarantine or stay-at-home policies, not on infected persons (IP) or their close contact persons (CP), who were legally enforced into quarantine by local public health departments.…”