Michael Joseph Dino1,2*
Chloe Margalaux Villafuerte2
Justin Pimentel2
Jerald Sayat2
Joseph Carlo Vital2
Danny Hernandez1
Ladda Thiamwong1
Veronica Decker1
Mona Shattell1
Luis Ezra Cruz3
Mary Leoncio4
Joshua Rejs Reyes5
Reylan David6
Jose Arnel Manalili6- 1College of Nursing, University of Central Florida, Orlando, FL, United States
- 2Research Development and Innovation Center, Our Lady of Fatima University, Valenzuela, Philippines
- 3The Libraries, De La Salle University, Manila, Philippines
- 4College of Pharmacy, Our Lady of Fatima University, Valenzuela, Philippines
- 5The Graduate School, University of Santo Tomas, Espana, Manila, Philippines
- 6College of Medicine, Our Lady of Fatima University, Valenzuela, Philippines
Introduction: The frontier of aerospace health integrates medicine, technology, psychology, and related disciplines. The field has evolved from its earlier emphasis on maintaining crew survival beyond Earth’s atmosphere to addressing the fundamental challenge of sustainable human space habitation. Despite the growing body of literature in aerospace health, a gap persists due to an overconcentration on synthesis studies with limited empirical validation and insufficient attention to higher-order human health needs, including psychosocial aspects. By examining existing literature, this systematic review aims to present the current landscape of aerospace health research and its future directions.
Methods: The research paper adopted an integrative review framework developed by Whittemore et al. (Journal of Advanced Nursing, 2005, 52(5), 546–553), comprising five stages: problem identification, literature search, data evaluation, data analysis, and data presentation.
Results and Discussion: The Results and Discussion are organized into three sections that reflect the study’s objectives: (1) to focus on bibliometric patterns of the field, (2) to demonstrate study purposes and health-related outcomes, and (3) to conduct keyword network analysis and thematic linkages among the included articles. Findings indicate that most studies reviewed in aerospace health involve multiple authors, show a notable increase after the COVID-19 pandemic, and are primarily concentrated in the Americas. The results can be attributed to the multidisciplinary nature of the aerospace industry, the post-pandemic expansion of space activities, and the dominance of U.S.-led space initiatives. In addition, article purpose and outcomes demonstrate eight themes identified across all articles, covered under: (1) Physiology and Health Risks, (2) Psychology and Behavior, (3) Pharmaceuticals and Interventions, (4) Product and Technology, (5) Profession and Training, (6) Process and Procedures, (7) Place and Environment, and (8) Policy and Strategy. Keywords and network analysis, on the other hand, determine six themes, namely: (1) Health Ecosystem, (2) Health Examination, (3) Health Education, (4) Health Engineering, (5) Health Estimation, and (6) Health Evidence.
Conclusion: Ultimately, the review presents a Torus Model and thematic analyses that map the current landscape of aerospace health research and provide insights for future directions of the field.
Systematic Review Registration: https://www.osf.io/97u8f
1 Introduction
Aerospace health is a rapidly developing area of inquiry that examines the physiological, psychological, and technological dimensions of human performance in aviation and space environments. The term “aerospace” encompasses the integrated field of air and space travel, including the science, technology, engineering, and health aspects that enable both. In health contexts, aerospace medicine focuses on the health, safety, and performance of crew members and passengers in air and space vehicles (Davenport et al., 2021). Over the years, human space exploration, along with commercial air travel and long-duration missions, has become increasingly important. Through studies of the space environment and testing of initial capabilities in Earth orbit, over 50 years of human activity in space have yielded benefits that improve society and the quality of life on Earth (NASA, 2013). This is evident in the contributed critical knowledge and advancements in satellite telecommunications, global positioning systems, and weather forecasting. Amidst these, it is well known that the aerospace environment presents extreme conditions for the human body, as exposure to microgravity and ionizing radiation can lead to both short- and long-term health problems (Kapoor et al., 2025). Thus, one major result of this is the creation of deleterious effects and obstacles for long-term space missions.
With the expansion of aerospace exploration, the need for comprehensive healthcare approaches is thus becoming increasingly urgent. Beyond NASA’s ongoing efforts, global organizations such as the United Nations Office for Outer Space Affairs (UNOOSA) are also advancing policies that promote the application of space technologies to strengthen global healthcare. Initiatives such as Massive Open Online Courses (MOOCs) on Space and Global Health further support this mission by raising awareness and expanding space and global health education amongst academics and organizations worldwide. Such initiatives are increasingly important because the space environment exerts profound physiological effects that impact nearly every human organ system. Factors in the space environment, such as microgravity, is shown to lead to weakened muscle functions, including the heart, reabsorption of weight-bearing bones (i.e., a major cause of increased fracture risks and kidney stones), reduction in blood volume, and other immunological, reproductive, and sensorimotor changes (Jemison and Olabisi, 2021).
While these physiological risks have been extensively documented in aerospace research, the literature remains fragmented across other fields, such as biomedical engineering and psychological domains. Studies are predominantly focused on clinical countermeasures (Khan et al., 2024) and technological innovations (Sharp et al., 2025), often overlooking broader health contexts, particularly psychosocial dimensions. As a result, current knowledge provides valuable insights into performance and adaptation but fails to offer a comprehensive synthesis as to how healthcare can be delivered systematically in aerospace environments. Currently, most aerospace health research is conducted in simulated or laboratory settings. Since several countries lack their own space agencies, researchers often have limited access to information and must rely on the few that provide open-access data (Rausser et al., 2023). Systematic reviews, integrative syntheses, and conceptual frameworks have become dominant forms of scholarly output, reflecting the field’s efforts to organize and interpret emerging research. Despite this increase in synthesized knowledge, a significant gap remains in the empirical validation of findings within actual aerospace environments.
To address these gaps, this systematic review aims to synthesize existing evidence on the current state of research in aerospace health. Specifically, this review (1) describes bibliometric characteristics of published papers, (2) thematizes article purposes and reported outcomes, and (3) performs a keyword network analysis to map conceptual linkages and emerging domains in the field of aerospace health. Beyond documenting biomedical and technological challenges, this analysis’s findings highlight the growing recognition that aerospace health requires attention not only to basic survival but also to higher-order human needs and psychosocial wellbeing.
2 Methods
This research paper adopted a systematic review following the stages developed by previous scholars (Whittemore and Knafl, 2005). The review process is outlined as follows: (a) problem identification, (b) literature search, (c) data evaluation, (d) data analysis, and (e) presentation. To ensure quality and consistency throughout the review process, a scoping review guideline, the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) (Moher et al., 2010) was used. This review was registered on OSF.io (embargoed) and received ethical clearance exemption from *** (2025-IERC-00737).
2.1 Stage 1: problem identification
This paper examines the current state of research in the emerging field of aerospace health. As an interdisciplinary domain that integrates medical, biological, and engineering sciences to address the physiological and environmental challenges posed by human activity in space, aerospace health is still in its developmental stage. A systematic review of existing literature is therefore essential to establish a clear understanding of the field’s present scope, prevailing limitations, and areas requiring further development. The following inquiries guided this systematic review: (1) What does the existing published literature describe about aerospace healthcare? (2) What trends and patterns exist in terms of article purpose and outcomes of aerospace healthcare? (3) What themes can be generated to describe the articles on aerospace healthcare?
2.2 Stage 2: literature search
Databases including Scopus, Web of Science, PubMed, and ProQuest were thoroughly searched for existing literature. Keywords, like “aerospace health,” “aerospace nursing,” “aerospace wellness,” are used to identify relevant literature (See Table 1. Database search strategy).
Table 1. Database search strategy.
2.3 Stage 3: data evaluation
A systematic review tool, Covidence, was used to assess the validity and methodological appropriateness of the included studies. All retrieved articles from the selected databases were uploaded into the application, where duplicate records were automatically detected and removed, both manually and by the system. Following this, a full-text review was conducted after at least two independent reviewers had completed the title and abstract screening. The principal investigator resolved any discrepancies or divergences among reviewers through data reconciliation and consensus agreement. The following inclusion criteria were then applied to determine the relevance of eligible full-text studies and guide the selection of related literature.
2.3.1 Study design
This review includes both empirical and theoretical research obtained from multiple academic databases. Empirical studies generate findings through the systematic collection of controlled, measurable, and reproducible data (Brass, 2006). Studies with outcomes derived from tested or validated data were therefore included. Theoretical research, such as experience reports, editorial articles, conceptual papers, and review articles, was also incorporated. These studies contribute by developing, refining, or evaluating models and frameworks relevant to the field (Olusegun et al., 2024). Including both empirical and theoretical work thus provides a comprehensive understanding of the current state and future directions of aerospace health research.
2.3.2 Language
Discourse on aerospace health is an emerging trend with a well-documented body of research that frequently cross-references related studies. Therefore, the interpretation of the data and the dissemination of the findings in this paper should be conducted in a medium accessible to the broader scientific community. This project selected articles written only in English to ensure accurate data interpretation and widespread accessibility of the study. The proportion of publications in English within science, mathematics, medicine, and engineering is predominant and continues to increase (Smith, 2003). Moreover, scientific research published in English attains greater visibility in international literature and fosters stronger connections with scientists worldwide (Huttner-Koros and Perera, 2016). Therefore, the selected articles for review are written in English because this is the primary language of global scientific discourse, with most peer-reviewed journals disseminating research in this language.
2.3.3 Focus
For this review, only studies addressing health concerns, health technology, and environment specific to aircraft and spacecraft operations were selected, ensuring that the focus remains on aerospace-related human health. The key difference between aircraft and spacecraft lies in the environments in which they operate. An aircraft is a machine designed or intended for flight, as defined by current regulations (Sheng, 2019). This suggests that aircraft are designed to fly within Earth’s atmosphere. Typical examples are airplanes, helicopters, gliders, and paramotors. Spacecraft are designed to operate outside Earth’s atmosphere. There are two types of spacecraft: earth-orbiting and deep-space. Their difference lies in that earth-orbiting spacecraft operate around Earth for applications such as communication, weather monitoring, and observation, while deep space spacecraft are typically used for the exploration of other planets and celestial bodies (Birur et al., 2003). Therefore, articles focusing on aircraft and spacecraft were selected to ensure relevance to human health, technology, and environmental issues in aerospace operations, both within and outside the Earth’s atmosphere. Following this, the authors employed the Mixed Methods Appraisal Tool (MMAT) to assess the methodological quality of the empirical studies included in the review. The Authority, Accuracy, Coverage, Objectivity, Date, and Significance (AACODS) checklist was utilized to evaluate the validity and credibility of the theoretical studies collected. Finally, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram was used to illustrate the data evaluation process, depicting the number of studies identified, screened, included, and excluded, along with the reasons for exclusion at each stage.
2.3.4 Keyword rationale
The keyword strategy was developed to align closely with the review’s focus on aerospace health, emphasizing terms directly related to health, human performance, and biomedical concerns in aerospace contexts (e.g., “aerospace health,” “aerospace medicine,” “space health”). Broader space-related terms, including references to specific mission environments such as Low Earth Orbit (LEO), Moon, or Mars, were considered within the overall conceptual landscape of aerospace research. Because the review concentrated on health-focused studies across both aviation and space settings, the final set of keywords was structured around terminology that most consistently reflected this domain.
Figure 1 (PRISMA diagram) illustrates the identification, screening, and inclusion process that was carried out using Covidence. A total of 251 duplicate references were removed from 494 studies in the databases. Ten are identified manually, and 241 are identified as duplicates by Covidence. Of the 243 studies screened, 153 were excluded based on their titles and abstracts because they did not meet the inclusion criteria outlined in Stage 2. From ninety (n = 90) studies that underwent full-text review, 29 were excluded because of wrong study design (n = 1), non-English language (n = 1), non-aerospace health (n = 10), and no full-text available (n = 17). Lastly, 66 studies are included in the review, all of which underwent network analysis.
Figure 1. PRISMA diagram.
2.4 Stage 4: data analysis
At least two authors independently extracted data from eligible studies using a systematic, interactive process to identify common patterns and emerging themes across the dataset. The data extracted from the included articles are as follows: (a) Bibliometrics which covered author, year of publication, bibliographic identifiers, article type, authorship, health journal, country of publication, and World Health Organization (WHO) region; (b) Critical Appraisal which included MMAT score for empirical research, AACODS score for theoretical studies, and relevance score; (c) Article Target in terms of topic, subtopic, health focus, health dimension, client status, sample size, and environment; (d) Research Data, which encompassed article purpose, outcome, and direction; and (e) Research Output.
Attaining a collective agreement among the group is given priority in any circumstances of conflicting judgment. Additionally, data reconciliation is facilitated using the Covidence Application to resolve discrepancies during screening and data extraction. Files were safeguarded in institutional databases after being accurately entered into a spreadsheet.
2.5 Stage 5: data presentation
Findings were organized into thematic tables and conceptual models, allowing the researchers to observe relationships, variations, and emerging patterns across the included studies. These models illustrate the mapped thematic areas and depict the overall landscape of aerospace health research.
3 Results
3.1 Article bibliometrics
Table 2 presents the bibliometric data for the 61 articles included in this study, covering the period from 1967 to 2025. The majority of this research is conducted by multiple authors (n = 44; 66.67%). Despite the aerospace nature of the topics, the reviewed articles are primarily published in health journals (n = 46; 69.70%). Geographically, the American region produced the most studies with (n = 38; 57.58%). Notably, most articles focus on creating Knowledge Synthesis and Reports (n = 38; 57.57%), thereby producing more Theory and Models (n = 52; 78.78%) than other output types. For the studies not focusing on creating synthesis and reports, most are set in a laboratory setting (n = 11; 16.66%).
Table 2. Article bibliometrics.
3.2 Article purpose and outcomes
The present literature review included 61 articles that assessed the current state of research on aerospace health from 1967 to 2025. Two primary areas were evaluated, specifically examining the purposes and outcomes of each study in relation to their key objectives and results. This ranges from research article titles and corresponding authors to quality checks via MMAT and AACODS, as well as purpose and outcome. To establish a clear distinction of emerging patterns, Table 3 synthesizes this individual information into thematized clusters that identify research trends. In terms of purpose, studies were classified into eight areas: (1) Physiology and Health Risks, (2) Psychology and Behavior, (3) Pharmaceuticals and Interventions, (4) Product and Technology, (5) Profession and Training, (6) Process and Procedures, (7) Place and Environment, and (8) Policy and Strategy. These thematic areas correspond to individual themes on both article purpose and outcomes, spanning the identification of health risks and physiological changes in the human body, mental health phenomena, resilience of pharmaceutical products, technology innovations, competency frameworks for health professionals, digital health tools, environmental changes, and finally, policy and strategy development for aerospace-related health. A comprehensive overview of the included studies is provided in the supplementary file.
Table 3. Thematized purpose and outcomes.
MMAT appraisal reveals that 25 studies were evaluated. Among these, eight studies (32%) achieved a score of 100%, indicating high methodological quality. Another twelve studies (48%) were rated at 80%, reflecting moderate quality, while five studies (20%) scored 60%, suggesting notable methodological limitations. Using the AACODS checklist, 41 non-empirical or grey literature sources were assessed. These generally rated highly in terms of Authority and Accuracy, as they were authored by domain experts and supported by credible evidence. However, variation was observed in Currency and Significance, with some studies providing outdated insights or limited applicability to aerospace healthcare.
While Table 3 summarizes the themes derived from the purposes and outcomes of the aerospace health articles and corresponding articles, Figure 2 illustrates these themes in a “torus” model—a fundamental geometric form found in nature at multiple scales and often viewed as a symbol of balance, renewal, and interconnectedness. Figure 2A shows a top view of the torus, where eight themes are arranged radially around a center, characterizing the themes of aerospace health research. This perspective was chosen to allow integration with symbolic shapes such as the octagon and delta, which symbolize “space.” On the other hand, Figure 2B illustrates an angled view of the model. The toroidal geometry model reflects how existing literature on aerospace health integrates knowledge in a self-sustaining loop across eight interconnected domains. It specifically provides a balanced framework in which areas (e.g., physiology, policy, technology) maintain their distinctions while being united by the flow of knowledge through continuous feedback loops. This emphasizes that themes bound research in the field of aerospace health but evolve endlessly through integrated insights.
Figure 2. Torus Model representing the themes on Aerospace health articles’ purpose and outcomes. (A) Top view of the model, (B) angled view of the Torus.
3.3 Article keyword network analysis
Figure 3 is a co-occurrence network of article keywords that reveals six thematic clusters (Table 4) from the systematic review, illustrating the characteristics of the existing literature on aerospace healthcare. The network showed that some of the most frequently occurring keywords include “human,” “space health,” “space research,” and “extraterrestrial environment,” represented by node sizes proportional to word frequency and lines indicating co-occurrence strength. Six keyword clusters, particularly “Health Ecosystem,” “Health Examination,” “Health Education,” “Health Engineering,” “Health Estimation,” and “Health Evidence.” The first cluster encompasses discussions on aerospace environments and their impacts on health. The second cluster is centered on health diagnostics. The third cluster relates to information on physiology, practice, and process. The fourth cluster addresses approaches for improving health and wellbeing through potential modifications in body system factors. The fifth cluster highlights health indicators, metrics, and measures. Finally, the sixth cluster pertains to health research, biomarkers, and functional assessment in aerospace. Together, these clusters provide a comprehensive view of the field, reflecting both foundational biomedical concerns and emerging directions in aerospace health.
Figure 3. Article keywords network map.
Table 4. Aerospace health article keyword clusters and themes.
4 Discussion
4.1 Article bibliometrics
Aerospace health studies predominantly featured multiple authors from both health and non-health scholars. One key contributor to this finding is the consistent increase in multiple authorship in aerospace health, spanning disciplines such as physical sciences, including physics and space sciences. For instance, despite some fluctuations in 2006, 2009, and 2010, authorship in physical science-related aerospace health shows an upward trend. From 1967 to 2019, publications in aerospace health were relatively sparse, with most years contributing one or two articles and occasional small peaks (e.g., 1989 and 2005 with two articles each). Beginning in 2020, there was a noticeable increase in research output, rising from four articles in 2020 and 2021 to 10 in 2022, peaking at 13 in 2024, and slightly decreasing to five in 2025 (Table 2). Other than years of publication, research in physics-related aerospace health is the largest, followed by space science (King, 2013). As an inherently interdisciplinary domain, aerospace health demands a comprehensive understanding that integrates health, technology, physics, and space science into a unified framework. In addition, space medicine is a field of study that seeks to understand medical challenges with space travel by applying multiple scientific approaches (Gunga, 2021). Hence, another contributing factor to the result is that aerospace health is an inherently interdisciplinary and multidisciplinary field that requires collaboration among various fields of study (medicine, engineering, physics, and astronomy). The results suggest that the advancement of allied disciplines (technology, physics, biomedicine, space chemistry, and space science) is integral to the development of aerospace health. Therefore, it is recommended to evaluate the current developments of related disciplines, as this provides a basis for projecting the future direction of aerospace health. Future trends may involve recalibrating the curriculum to include courses on aerospace health or developing academic programs tailored to professional practice in space medicine. New research methods must be designed for aerospace health-related investigations.
Findings reveal a growing number of publications on aerospace health from 2020 to the present. A steady rise was observed from 2020 to 2021, peaking from 2022 to 2023. This trend can be attributed to several factors, including the parallels between human health conditions during the COVID-19 pandemic and those experienced in spaceflight, recent discoveries suggesting the possibility of life on other planets, the undertaking of long-duration space missions, and the emergence of space tourism. There has been a surge of studies focused on aviation and aerospace health following the COVID-19 pandemic. Given the significant impact of this health crisis across all areas of life, many studies have examined its role and effects (Sun et al., 2021). This research addition spanned multiple academic venues, including aviation-specific conferences and journals, transportation and health-related publications, and economics and law journals (Sun et al., 2022). Research in aerospace medicine identified pandemic-related impacts as a critical focus area, with the field receiving numerous submissions related to the effects of SARS-CoV-2 on flight (Scheibler et al., 2023). For instance, knowledge on disease prevention and protocols for human spaceflight (Petersen et al., 2021), development of new clinical and operational guidelines for flight crew members (Osborn et al., 2020), and advances in space medicine research were specifically applied to pandemic management on Earth, with aerospace medical research serving as a resource to improve terrestrial medical care during COVID-19 (Cinelli and Russomano, 2021).
Moreover, the interconnectedness of human health conditions in space bears a striking resemblance to the observed condition of humans during a pandemic (COVID-19). The increase in aerospace health publications during the COVID-19 pandemic may be attributable to the recognition that some of the human body’s responses in space share similarities with those seen in COVID-19. Both spaceflight and COVID-19 involve changes in the immune system, including increases in specific inflammation markers, such as interleukin-6 (IL-6) (Melnick et al., 2020). IL-6 has been widely studied during the pandemic because it is associated with more severe illness and has also been observed to rise during spaceflight due to stressors such as microgravity and radiation (Smith, 2018; Wang et al., 2022). This overlap prompted researchers to compare astronaut health with COVID-19, leading to greater interest in topics such as immune function, inflammation, and countermeasures. As a result, space medicine was increasingly viewed as relevant to broader public health challenges, contributing to the growth of aerospace health research during the pandemic years.
Ongoing developments in Mars exploration have provided promising insights into the possibility of extraterrestrial life, prompting further studies on the planet’s habitability and potential for future human colonization. The Perseverance Rover, deployed during the Mars 2020 mission to explore the planet’s ancient habitability through geological sampling (Thanadulsatit et al., 2024), has identified various mineral, chemical, and organic patterns that point to the possibility of biosignatures within the bright-toned outcrop observed on the northern margin of Neretva Vallis called Bright Angel formation (Hurowitz et al., 2025). While this discovery still requires verification through subsequent rock sampling and analysis, this provides the most prominent indication of life on another planet to date. As a result, studies emphasizing human adaptation and colonization in the aerospace environment have significantly expanded. The ongoing expansion of long-duration space missions from 2020 to the present may have contributed to the significant growth in interest in aerospace health. Artemis 1 started in 2022, during which time they tested out the ground systems, rocket, and spacecraft without a crew (Krishna, 2025). The further development of this project leads to Artemis 2, in which humans will be sent around the moon. The Artemis program represents a shift from Apollo’s temporary lunar missions toward developing a sustainable human presence on the moon. The project aims to learn how to survive and work in the moon’s environment (Krishna, 2025). This project alone led to the development of multiple studies exploring ways to survive in the aerospace environment, potentially for space tourism.
Space tourism was first introduced when Denis Tito successfully visited the International Space Station in 2001, and before that, only federal astronauts were permitted to travel to space (Chang, 2015). Space tourism gained significant popularity in 2021 with the emergence of various private space ventures. In July 2021, Blue Origin successfully conducted its first launch, followed by Virgin Galactic. Moving on to September 2021, SpaceX achieved another milestone with the launch of Dragon Resilience (Pallathadka and Pallathadka, 2022). More recently, Blue Origin’s all-female space mission, featuring celebrities, further highlighted the growing accessibility and appeal of commercial space travel (Jessen, 2025). These privately funded space programs are a turning point for space tourism. This implies that multiple studies on aerospace health have arisen from this trend to assess the feasibility of human spaceflight (by determining risk and hazard). Therefore, the increase in aerospace health studies runs parallel with the growing demand for long-duration space travel, and the increase in aerospace health research output since 2020 can be interpreted as a transitional phase to heightened interest and a more defined research field, marking the shift of space exploration from a mere aspiration to a recognized public need. Thus, it is recommended that the scientific community foster aerospace health research by developing promising theories and models to meet the growing needs of space exploration.
Results also showed that among all World Health Organization (WHO) regions, the Americas are the predominant contributor to aerospace health research, primarily from the United States of America. This outcome may be linked to the United States of America’s position as a frontrunner in aerospace exploration, which also extends to aerospace health. In addition, a majority of leading initiatives in space exploration are spearheaded by NASA (National Aeronautics and Space Administration) and major commercial companies such as SpaceX, Blue Origin, and Axiom Space, all based in the United States of America. According to NASA’s Annual Highlights Report for 2024, bibliometric analyses revealed that the United States accounted for 23% of international collaborations in space research, making it the leading country in global space research partnerships. The same report documented 361 publications for fiscal year 2024, of which 80% were sponsored by NASA and the Japan Aerospace Exploration Agency (NASA, 2025). This implies that aerospace research is highly concentrated in the United States, reflecting the country’s technological advancements, funding capacity, and institutional dominance in space science. As the United States has shaped the discourse on aerospace health, a global collaboration among other WHO regions is encouraged to globalize aerospace research. Publications were categorized according to the World Health Organization (WHO) regional classification system, and this approach causes an overrepresentation of the Americas since, under that region, the United States (a country that produces significant aerospace research) is included, even though other countries in the same region do not engage in aerospace research to the same extent. Hence, it is recommended for future analyses to consider alternative regional or country-specific classifications to ensure a more balanced representation of global research contributions.
Research in aerospace health is primarily driven by the synthesis and review of previously published articles. Space exploration limitations hinder the collection of additional data samples, as aerospace research is costly. Aerospace health is still in an exploratory infancy stage (navigating the “unknown”), and currently, NASA faces challenges such as reduced government funding, leading to increased reliance on private funding sources (Rausser et al., 2023). Additionally, environmental issues, including the accumulation of debris in low-Earth orbit, pose collision risks and threaten to make orbital environments economically unsustainable (Smith, 2023). Further use of existing studies can help develop ways to overcome space exploration limitations, such as funding and resource constraints, and to leverage modern technological innovations to bypass low-Earth-orbit debris. For the time being, simulated environments for “earth-based” studies in aerospace health should be considered to support continuous efforts in this area.
4.2 Article purpose and outcomes
The summary article’s purpose and outcomes communicate various themes that encompass the objectives and results of all included studies in the present literature review. First, it was conveyed that aerospace health research primarily focuses on safeguarding and maintaining human physical health, hygiene, and stability during space missions. A potential association may be found in the fact that human safety is the top priority, in which ensuring the wellbeing of astronauts and humans beyond Earth’s bounds, as well as low-orbit satellites, is crucial for the next level of development in longer, deeper space travel. Health risks from deep-space exposure remain uncertain and poorly understood, and technologies to mitigate them are underdeveloped. Along with isolation from expert care, health monitoring and prevention are therefore key priorities for ensuring human safety and health during space missions (Rajput et al., 2023). This implies that the uncertainty of the space environment makes it crucial that astronaut and personnel health monitoring be prioritized in aerospace healthcare. To enhance astronaut safety, future studies should focus on understanding and mitigating the risks currently identified in space environments.
It was found that advancements in the development of policies and procedures for aerospace health are relatively limited. Given the limited progress in developing policies and procedures in aerospace health over the years, there is a clear need for further advancement in this area. Limitations in advancing aerospace health policies may be attributed to the novelty of human space exploration, a relatively small and specialized population eligible for study, and logistical barriers to health research (Dev et al., 2024; Kahn et al., 2014; Lester and Robinson, 2009). At the scientific level, this constrains the development of standardized research and affects the integration of biomedical theories into practice. Ethically, this lack of robust policies creates uncertainty about astronaut health, undermining public trust and slowing broader participation in human space exploration (Detsis, 2022). A global approach is hence necessary in developing policies and standards. It will be helpful for future efforts to prioritize establishing clear, evidence-based health procedures that can be adopted across disciplines in aerospace health. This will strengthen astronaut safety and build public trust, both of which are necessary for the sustainability of long-duration space missions.
Findings also revealed that there are limited studies that review the role of medical practitioners and personnel. Even within aerospace medicine, research has prioritized engineering-oriented approaches in managing healthcare in space. Streamlined healthcare delivery systems extend healthcare reach to remote and underserved areas with round-the-clock availability (Anawade et al., 2024), including space. Biosensors, for instance, are leading a revolution in healthcare and ultimately, in life itself. This technological advancement marks a shift toward a more proactive, preventive approach to medical care (Vo and Trinh, 2024). This involves the further application of systems engineering principles that draw on best practices, as well as the adaptability of existing systems to better manage healthcare risks (Aujla et al., 2024). However, despite this growing reliance on technology-driven approaches, there remains a shortage of system engineers who are skilled in the healthcare domain and its unique challenges (Ferreira et al., 2023). Healthcare development relies on an engineering-based approach to enable the proactive identification and management of risks, particularly in situations where patients or subjects, such as astronauts, are beyond the direct care of medical professionals. It is critical to develop a balanced approach to health technology development, involving collaboration between healthcare professionals and system engineers, and to establish a competency framework to guide human resources training for health.
Lastly, it was observed that pharmaceutical and biomedical interventions have primarily been tested in simulated environments and/or on animal subjects due to the significant risks and safety concerns associated with involving human participants. These limitations are further driven by ethical and logistical constraints in conducting experimental interventions directly on astronauts. Given the limited number of trained and certified astronauts, ensuring their safety remains the foremost priority in aerospace health research. The small number of individuals who have ventured into space represents an invaluable data source that can inform future safety measures and enhance the success of upcoming space missions (Corlett et al., 2020). These findings underscore the critical importance of astronaut health and safety, not only for maintaining scientific integrity and mission success, but also for providing unique data essential to advancing human space exploration. Consequently, specialized protocols for pharmaceutical and biomedical applications in aerospace contexts may be necessary. Moreover, with the recent commercialization of space travel, broader participation could generate additional data on the physiological effects of space exposure, including polypharmacy and drug–drug interactions, which represent promising areas for future research.
In the eight themes summarized by Figures 2A,B, the Torus Model encapsulates geometric forms that visually represent how current knowledge on aerospace health operates as an interconnected system. The top-view torus displays eight key research areas: Physiology and Health Risks, Psychology and Behavior, Pharmaceuticals and Interventions, Product and Technology, Profession and Training, Process and Procedures, Place and Environment, and Policy and Strategy, all arranged radially around a center. The circular geometry emphasizes that every domain contributes equally to the core of research on aerospace health and that no single area functions in isolation. The radial symmetry, also highlighted by the delta and octagon, reflects the balanced contribution of each area. Correspondingly, the angled view of the toroidal shape symbolizes an ongoing, cyclical process in which knowledge circulates among all eight academic areas through a continuous feedback loop. This mirrors the real-world nature of research in this field, where advancements in one facet often drive the rise of new procedures, policies, or adaptations. Complementing this geometric structure, the network of lines that generally connects these domains further illustrates how research in one area consistently informs and strengthens findings in others. For instance, studies in Physiology and Health Risks often intersect with Psychology and Behavior (e.g., stress responses), Pharmaceuticals and Interventions (e.g., countermeasures), and Product and Technology (e.g., equipment performance). Fundamentally, the Torus Model’s geometric forms depict the non-linear, multidirectional flow of knowledge across the eight research disciplines, which align with the integrative nature of aerospace health knowledge.
4.3 Article keyword network analysis
Thematic assessment of keyword network analysis revealed that aerospace health research is organized around ecosystems, diagnostics, education, biomedical engineering, health indicators, and empirical evidence. This may stem from the condition that aerospace health is multidimensional, with heavy influence from other non-health fields. Addressing astronaut health requires a systems-level perspective, in which expertise from medicine, engineering, behavioral sciences, and education converge to develop adaptive, evidence-based strategies. Given that aerospace health research is inherently multidisciplinary, diverse challenges from diagnostics and biomedical engineering to education and health indicators require specialized lines of inquiry (Chen et al., 2025). Apart from this, fragmented institutional priorities at the early stage of development of these fields may also have contributed to the clustering of research across various areas. Just as medical education seeks to unify basic science and clinical practice through systems thinking, aerospace health demands a similar integrative approach that synthesizes adaptive strategies for aerospace care in evolving environments (Aron, 2017).
Outcomes in this area suggest that improvement in aerospace health research requires not only continued advances in the hard sciences and engineering but also deliberate attention to the psychosocial dimensions of aerospace healthcare. This reflects the “Maslow’s Effect,” where scientific development follows the pattern of Maslow’s Hierarchy of Human Needs, addressing basic physiological and safety needs with high priority before belongingness and self-actualization. For instance, the field of robotics initially focused on core functions, such as stability and locomotion, but has since expanded to higher-order concerns, including emotional intelligence and human-robot interactions (Dino et al., 2022; Mahdi et al., 2022). Similarly, the development of digital technologies has evolved beyond automation to support complex fields such as forensic sciences, serving human-centered needs by protecting human welfare, justice, and safety (Dino et al., 2025). Public health, which initially focused on controlling infectious diseases, sanitation, and vaccination in the early years, later evolved to emphasize mental health and quality of life to better understand human health needs (Tulchinsky and Varavikova, 2014). Therefore, future researchers in the field of aerospace health are expected to focus on higher-order needs such as Love and Belonging, Esteem, and Self-Actualization (Kenrick et al., 2010) to support holistic wellbeing and long-term mission success.
5 Conclusion
This systematic review on aerospace health research aimed to (1) describe bibliometric characteristics of published papers, (2) thematize article purposes and reported outcomes, and (3) perform a keyword network analysis to map conceptual linkages and emerging domains in the field of aerospace health. Bibliometric analysis revealed that aerospace health research is increasingly multi-authored and interdisciplinary, with publications rising since 2020, peaking in 2022–2023, and led predominantly by scholars from the Americas (i.e., the United States). The field also remains primarily driven by reviews and syntheses rather than empirical studies, reflecting its ongoing consolidation. In terms of purpose and outcomes, eight themes emerged that summarize the areas of research in aerospace health: Physiology and Health Risks, Psychology and Behavior, Pharmaceuticals and Interventions, Product and Technology, Profession and Training, Process and Procedures, Place and Environment, and Policy and Strategy. Building on these results, a conceptual model was generated using a space-inspired geometric figure, the Torus Model, to visually represent how these eight themes form an interconnected, self-sustaining system of knowledge within aerospace health research. Finally, keyword network analysis demonstrated that research in the field is structured around six interrelated themes: Health Ecosystem, Health Examination, Health Education, Health Engineering, Health Estimation, and Health Evidence. While aerospace health is still in its formative or infancy stage, this review may serve as a reference for policy and standards development and for developing a roadmap for aerospace health and associated healthcare provider competencies. This study also offers critical insights to inform future research and innovation in health technologies. Future developments should extend beyond basic survival measures to integrate psychosocial support systems that foster higher-order human wellbeing and mission resilience.
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Author contributions
MD: Conceptualization, Funding acquisition, Validation, Resources, Visualization, Project administration, Data curation, Methodology, Writing – review and editing, Formal Analysis, Software, Supervision, Investigation, Writing – original draft. CV: Validation, Resources, Conceptualization, Project administration, Writing – review and editing, Data curation, Formal Analysis, Software, Funding acquisition, Writing – original draft, Methodology, Investigation, Supervision, Visualization. JP: Writing – review and editing, Conceptualization, Supervision, Software, Writing – original draft, Methodology, Investigation, Resources, Project administration, Visualization, Funding acquisition, Data curation, Formal Analysis, Validation. JS: Writing – review and editing, Validation, Software, Resources, Investigation, Funding acquisition, Visualization, Methodology, Data curation, Project administration, Writing – original draft, Formal Analysis, Conceptualization, Supervision. JV: Funding acquisition, Software, Writing – review and editing, Resources, Investigation, Visualization, Formal Analysis, Writing – original draft, Validation, Data curation, Conceptualization, Supervision, Project administration, Methodology. DH: Software, Supervision, Funding acquisition, Writing – original draft, Writing – review and editing, Resources, Formal Analysis, Methodology, Data curation, Visualization, Investigation, Project administration, Conceptualization, Validation. LT: Visualization, Funding acquisition, Formal Analysis, Resources, Project administration, Conceptualization, Validation, Data curation, Software, Methodology, Writing – review and editing, Supervision, Investigation, Writing – original draft. VD: Funding acquisition, Supervision, Writing – review and editing, Conceptualization, Software, Project administration, Formal Analysis, Writing – original draft, Methodology, Resources, Data curation, Visualization, Investigation, Validation. MS: Data curation, Software, Project administration, Conceptualization, Visualization, Validation, Methodology, Writing – review and editing, Supervision, Funding acquisition, Writing – original draft, Investigation, Resources, Formal Analysis. LC: Writing – original draft, Resources, Formal Analysis, Funding acquisition, Writing – review and editing, Visualization, Project administration, Methodology, Software, Data curation, Conceptualization, Supervision, Investigation, Validation. ML: Funding acquisition, Writing – original draft, Writing – review and editing, Software, Resources, Visualization, Formal Analysis, Project administration, Conceptualization, Supervision, Validation, Methodology, Data curation, Investigation. JR: Validation, Writing – review and editing, Conceptualization, Methodology, Funding acquisition, Supervision, Investigation, Resources, Software, Formal Analysis, Project administration, Writing – original draft, Data curation, Visualization. RD: Resources, Funding acquisition, Visualization, Formal Analysis, Software, Writing – review and editing, Data curation, Writing – original draft, Conceptualization, Methodology, Validation, Project administration, Supervision, Investigation. JM: Investigation, Writing – review and editing, Conceptualization, Funding acquisition, Supervision, Resources, Writing – original draft, Software, Project administration, Validation, Visualization, Methodology, Data curation, Formal Analysis.
Funding
The author(s) declared that financial support was not received for this work and/or its publication.
Conflict of interest
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The author MD declared that they were an editorial board member of Frontiers at the time of submission. This had no impact on the peer review process and the final decision.
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Keywords: aerospace health, network analysis, space flight, space health, systematic review
Citation: Dino MJ, Villafuerte CM, Pimentel J, Sayat J, Vital JC, Hernandez D, Thiamwong L, Decker V, Shattell M, Cruz LE, Leoncio M, Reyes JR, David R and Manalili JA (2026) Aerospace health: a systematic review and current state of science. Front. Space Technol. 7:1736627. doi: 10.3389/frspt.2026.1736627
Received: 31 October 2025; Accepted: 09 January 2026;
Published: 29 January 2026.
Edited by:
Volker Hessel, University of Adelaide, AustraliaReviewed by:
T. John Tharakan, Indian Space Research Organisation, IndiaFunmilola A. Oluwafemi, National Space Research and Development Agency (NASRDA), Nigeria
Copyright © 2026 Dino, Villafuerte, Pimentel, Sayat, Vital, Hernandez, Thiamwong, Decker, Shattell, Cruz, Leoncio, Reyes, David and Manalili. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Michael Joseph Dino, bWljaGFlbGpvc2VwaC5kaW5vQHVjZi5lZHU=