Heart Disease Topped Reasons for Excess Deaths in Puerto Rico After Hurricane Maria

Heart disease was the number one reason for “excess deaths” after Hurricane Maria struck Puerto Rico in September 2017, according to a new study out Thursday.

Other studies have estimated the number of such deaths in the aftermath of the storm, but this is the first to categorize them by cause.

According to the research published in The American Journal of Public Health, 253 excess deaths—deaths that would not have occurred if it were not for the storm—were attributed to heart disease.¹ Excess deaths from “other” causes were estimated at 204 deaths, diabetes at 195 deaths, Alzheimer disease at 122 deaths, and septicemia at 81 deaths.

The deaths probably stemmed from a lack of treatment, the authors noted.

In the aftermath of the storm, some providers left the island; in addition, the elderly and those with chronic conditions were likely left without younger caregivers, who also left. Power outages and damaged or destroyed facilities also hampered timely care.

To create the estimates, researchers pulled monthly vital statistics data on all deaths from January 2008 through October 2017. They then conducted a time-series analysis to estimate excess mortality in September and October 2017 overall and by age, sex, and cause of death.

The estimates of excess deaths were more or less in line with previous reports. Researchers estimated a total of 1205 excess deaths (95% CI, 707-1702). Excess deaths were slightly higher among men than women (632 and 579 deaths, respectively) and found only among people 60 years or older (1038 deaths).

Researchers said that an accurate accounting of the top reasons for excess deaths can “help authorities plan resource allocation for the island’s recovery and for the prevention of deaths in future disasters.”

Those disasters seem more likely, as Puerto Rico has not recovered from the first storm; another recent paper said the storm was the worst the island has ever experienced and said climate change played a role.²

The paper, published in Geophysical Research Letters, analyzed the extreme rainfall from Hurricane Maria using 35 historical weather stations with daily precipitation data from 1956 to 2016 and found that the hurricane dumped the most amount of rain in a single day since 1956. Long-term climate trends are a factor in the extreme precipitation, the paper said.

Meanwhile, recovery efforts to repair the $90 billion worth of damage are lagging; most recently, Congress and President Donald Trump failed to resolve an impasse over disaster aid. Rep. Nita Lowey, D-New York, has introduced a bill for $17.2 billion in emergency supplemental appropriations, as well as $3 billion for the Midwest, which recently flooded.

There have been various estimates of the number of deaths in Puerto Rico. A 2018 study commissioned by the governor of the island found total excess mortality of 2975 deaths in the 6 months after Hurricane Maria, revising its official death of 64. A study published in The New England Journal of Medicine estimated the deaths at more than 4600. Another study, which also used vital statistics records, estimated the number at 1139.

The authors of the current analysis said that their method of using a time-series analysis overcomes weaknesses of earlier studies, which they said failed to account for long-term trends and seasonal patterns in mortality, as well as “significant secular changes in population size.”

References

1. Cruz-Cano R, Mead EL, PhD. Causes of excess deaths in Puerto Rico after Hurricane Maria: a time-series estimation [published online April 18, 2019]. Am J Public Health. doi: 10.2105/AJPH.2019.305015.

2. Keellings D, Hernández Ayala JJ. Extreme rainfall associated with Hurricane Maria over Puerto Rico and its connections to climate variability and change [published online March 4, 2019]. Geophys Res Lett. doi: 10.1029/2019GL082077.