title: Burden of cardiovascular morbidity and mortality following humanitarian emergencies: a systematic literature review.
abstract: BACKGROUND
  The global burden of cardiovascular mortality is increasing, as is the number of large-scale humanitarian emergencies. The interaction between these phenomena is not well understood. This review aims to clarify the relationship between humanitarian emergencies and cardiovascular morbidity and mortality.
  
  
  METHODS
  With assistance from a research librarian, electronic databases (PubMed, Scopus, CINAHL, and Global Health) were searched in January 2014. Findings were supplemented by reviewing citations of included trials. Observational studies reporting the effect of natural disasters and conflict events on cardiovascular morbidity and mortality in adults since 1997 were included. Studies without a comparison group were not included. Double-data extraction was utilized to abstract information on acute coronary syndrome (ACS), acute decompensated heart failure (ADHF), and sudden cardiac death (SCD). Review Manager 5.0 (Version 5.2, The Nordic Cochrane Centre; Copenhagen Denmark,) was used to create figures for qualitative synthesis.
  
  
  RESULTS
  The search retrieved 1,697 unique records; 24 studies were included (17 studies of natural disasters and seven studies of conflict). These studies involved 14,583 cardiac events. All studies utilized retrospective designs: four were population-based, 15 were single-center, and five were multicenter studies. Twenty-three studies utilized historical controls in the primary analysis, and one utilized primarily geographical controls.
  
  
  CONCLUSIONS
  Conflicts are associated with an increase in long-term morbidity from ACS; the short-term effects of conflict vary by study. Natural disasters exhibit heterogeneous effects, including increased occurrence of ACS, ADHF, and SCD.
  
  
  CONCLUSIONS
  In certain settings, humanitarian emergencies are associated with increased cardiac morbidity and mortality that may persist for years following the event. Humanitarian aid organizations should consider morbidity from noncommunicable disease when planning relief and recuperation projects.
authors.affiliation: 1Johns Hopkins Bloomberg School of Public Health,Baltimore,MarylandUSA.
authors.forename: Kaitlin G
authors.initials: KG
authors.lastname: Hayman
authors.affiliation: 1Johns Hopkins Bloomberg School of Public Health,Baltimore,MarylandUSA.
authors.forename: Davina
authors.initials: D
authors.lastname: Sharma
authors.affiliation: 3Johns Hopkins University School of Medicine,Baltimore,MarylandUSA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Wardlow
authors.affiliation: 4Center for Public Health and Human Rights,Johns Hopkins Bloomberg School of Public Health,Baltimore,MarylandUSA.
authors.forename: Sonal
authors.initials: S
authors.lastname: Singh
mesh_terms: D000533:Altruism; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D004189:Disaster Planning; D004190:Disasters; D006801:Humans; D012307:Risk Factors; D014857:Warfare
keywords: ACS acute coronary syndrome; ADHF acute decompensated heart failure; AMI acute myocardial infarction; ED emergency department; ER emergency room; IHD ischemic heart disease; NSTEMI non-ST segment myocardial infarction; OHCA out-of-hospital cardiac arrest; SCD sudden cardiac death; SMR standardized mortality ratio; STEMI ST-segment myocardial infarction; UA unstable angina; heart diseases