Abstract
BACKGROUND Hurricane Maria made landfall in Puerto Rico on September 20, 2017. As recently as May of this year (2018), the official death count was 64. This figure was criticized for being overly optimistic by groups with access to September and October demographic registry data. However, because the government was not making all post-hurricane mortality counts publicly available, fully understanding the hurricane’s effect was challenging. A study describing a household survey, published on May 29, 2018, reported a much higher death count estimate, as well as evidence of population displacement, extensive loss of services, and a prolonged death rate increase lasting until the end of the survey period. Three days after this report was published, the government released death registry data. Here we use these data as well as data from other states to provide a detailed description of the effects on mortality of hurricane Marfa. We compare these effects to those of other hurricanes.
METHODS We fit a statistical model to mortality data that accounts for seasonal and non-hurricane related yearly effects. We then estimated the deviation from the expected death rate as a function of time using natural cubic splines that allowed discontinuities at hurricane landfall dates. We fit this model to 1985-2018 Puerto Rico daily data, which includes the dates of hurricanes Hugo, Georges, and María, 2015-2018 Florida daily data, which includes the dates of hurricane Irma, 2002-2004 Louisiana monthly data, which includes the date of hurricane Katrina, and 2000-2016 New Jersey monthly data, which includes the date of hurricane Sandy.
RESULTS We estimated death rate increases on the day of the hurricane of 689%, 74%, 33%, 10%, and 2% for Katrina, María, Georges, Hugo, and Irma, respectively. No increase was noted for Sandy. We find a prolonged increase in death rate after María and Katrina, lasting at least 207 and 125 days, resulting in excess deaths estimates of 3,433 (95% CI, 3,189-3,676), and 1,832 (95% CI, 1,600-2064) respectively, showing that María had a more long term damaging impact. Surprisingly, we also find that in 1998, Georges had a comparable impact to Katrina’s with a prolonged increase of 106 days resulting in 1,427 (95% CI, 1,247-1,607) excess deaths. For Hurricane María, we find sharp increases in a small number of causes of deaths, including diseases of the circulatory, endocrine and respiratory system, as well as bacterial infections and suicides.
CONCLUSIONS Our analysis suggests that since at least 1998, Puerto Rico’s health system has been in a precarious state. Without a substantial intervention, it appears that if hit with another strong hurricane, Puerto Ricans will suffer the unnecessary death of hundreds of its citizens.
Footnotes
↵* rafa{at}jimmy.harvard.edu
