Conceptualizing chronic noncommunicable diseases in disaster settings from a gender perspective: A systematic review

Objective: Approximately half of all deaths among women and those assigned female at birth in low-and middle-income countries (LMICs) are attributable to noncommunicable diseases (NCDs). LMICs are not only disproportionately affected by NCDs but also experience the largest burden of humanitarian emergencies. Yet the literature describing sex-and gender-based trends in NCDs in disaster settings is limited. This systematic review assesses sex-and gender- based epidemiology, interventions, and treatment of four NCDs (cardiovascular disease, cancer, chronic respiratory disease, and diabetes) in disaster settings using a thematic analysis approach. Design: Formal search strategies used relevant controlled vocabulary terms and synonymous free-text words and phrases to capture the concepts of NCDs and humanitarian emergencies. We manually identified articles that reported sex-and gender-based differences in NCD epidemiology, healthcare access, or health outcomes among populations in disaster settings. Two separate screeners independently evaluated the titles, abstracts, and full text of the eligible articles, with vetting by a third reviewer. Results: Women were found to bear a disproportionate burden of NCDs associated with disaster-related stress, care-seeking behaviors, and a lack of empowerment to engage in disease management. Cancers that predominantly affect females were identified as common reasons for seeking care during humanitarian crises. NCDs associated with or exacerbated during pregnancy, such as hypertensive disorders, had lower odds of care and resulted in worse outcomes. Conclusions: Although we found frequent sex-based disparities in the context of healthcare access, disease prevalence, and health outcomes, no study specifically investigated the role of gender or sex in NCD care.