Associations between Natural Disasters and Health System Disruptions: A Systematic Review Protocol of Disaster-related Population Health Impacts

The objective of this review is to assess the association between natural disasters and health system disruptions in the United States. Prior research has shown exposure to natural disasters impacts immediate, short-term, and long-term health outcomes through multiple pathways, including through health system disruptions. While evidence on natural disasters’ impacts on health systems has been synthesized for specific contexts (i.e., oncology care disruptions, lower-to-middle income countries, etc.), a systematic review has yet to be conducted to assess the association between natural disasters and health system disruptions in the United States. The purpose of this systematic review is to synthesize and critically evaluate the existing evidence on associations between natural disaster exposure and health system disruptions in the United States. Specifically, this review will examine empirical studies that assess health system disruptions and population-level outcomes after disasters, with attention to outcome domains, study designs, geographic scale, and methodological approaches. By focusing explicitly on natural disasters and health system disruptions in the United States, this review aims to address a critical gap in the disaster health literature and provide a clearer evidence base to inform future research, policy, and public health practice in the context of increasingly severe and frequent disasters.