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Blue Chip Panel Of
Epidemiologists And Other Experts Report On Mortality Associated With
Hurricane Maria In Puerto Rico
Collaborative
Group Estimates 2,975 Excess Deaths Over
A Six-Month Period
Loss Of
Life Is Nearly Identical To 9/11 Attacks
An
independent assessment of the deaths caused by Hurricane Maria in
Puerto Rico last year has been conducted and reported by the George
Washington University School of Public Health.
To establish the baseline or
expected mortality prior to the hurricane, investigators examined
mortality data from July 2010 to August 2017 and developed a series of
generalized linear models.
Excess Deaths
Researchers estimated that 2,975 more deaths occurred during the
six-month period September 2017-February 2018 after the hurricane than
would have taken place without the storm. The excess number is almost
identical to the loss of life associated with September 11 attacks.
Overall the study documented 16,608 deaths during the study period.
The
excess number of deaths represents a 22% increase over the number of
deaths that would have occurred without the storm. Initial estimates
were that 64 people had died, but this number appeared from
preliminary investigations to be an underestimate. These discrepancies
prompted the Governor of Puerto Rico to request an independent study
by George Washington University.
Risk Factors
According to the report, the impact of the storm differed by
municipality, age and socioeconomic status. Some 40% of municipalities
were affected with significantly higher mortality. It was 60% higher
in lower socioeconomic areas and 35% higher for males aged 65 or
older. In a press release from GWU, Carlos Santos-Burgoa who
was the principal investigator for the project said “The
results of our epidemiological study suggest that, tragically,
Hurricane Maria led to a large number of excess deaths throughout the
island.”
Shifting Denominator
Interestingly, the research group estimated there were
297,744 fewer persons on the island in February 2018 compared to when
the storm hit in September 2017. This represents a migration of 8% and
the mortality rates were calculated taking this displacement into
consideration.
The team noted that the elevated risk they found
persisted beyond the six-month observation period and may thus still
be an underestimate.
Other Studies
The research group conducted multiple interviews and
analyses of death certificate data to identify flaws in mortality
surveillance and communications activities during the storm period.
The report provides a number of key recommendations:
All jurisdictions, not only Puerto Rico and other parts
of the U.S. but also globally, should develop methods to rapidly
assess total excess mortality after natural disasters and to provide
that information to the public. Monitoring should look not only at
overall rates of death but also for spikes in death rates in certain
areas and within subpopulations, such as the elderly.
Puerto Rico specifically needs to fully staff these
public health functions within the Department of Health, including the
Vital Statistics Registry and the Bureau of Forensic Sciences.
In addition, the island must strengthen the
coordination between the Vital Statistics Registry and the Bureau of
Forensic Sciences with the goal of creating a timely and accurate
surveillance system.
Outside disaster assistance agencies,
including the U.S. Centers for Disease Control and
Prevention, need to provide aid and assistance
to professional staff involved in natural disasters.
Puerto Rico needs to conduct after-action reviews and
use those, along with the results of the study, to create a new crisis
and emergency risk communication plan, one that is integrated with
government agency and municipal plans, has community and stakeholder
involvement, and is aligned with the possibility of
catastrophic disasters.
Additional research must be done to
understand how the hurricane was involved in the excess deaths
identified in this study. This would involve interviews of family
members and others, as well in-depth statistical
analyses, to learn about the circumstances leading up to individual
deaths. Such a study can provide clues that will aid in protecting
vulnerable groups in the future.
Investigators And Staff
The blue chip panel of investigators and staff who carried out the
study are listed below, including their titles and/or diverse areas of
expertise.
Dr. Elizabeth
Andrade,
Dr.P.H., M.P.H. Behavioral Scientist, Project Researcher
Nicole Barrett,
M.P.H. Senior Research Associate, Project Research Assistant
Dr. Uriyoan
Colon-Ramos,
Sc.D., M.P.A. Nutritionist, Project Researcher
Dr. Mark Edberg,
Ph.D., M.A. Anthropologist, Project Researcher
Alejandra Garcia-Meza,
M.P.H. Consultant, Project Researcher
Dr. Ann Goldman,
Ph.D., M.P.H, M.A. Epidemiologist, Economist, Project Coordinator
Dr. Lynn Goldman,
M.D., M.S., M.P.H. Dean of the Milken Institute School of Public
Health, Environmental Health Specialist, Project Researcher
Dr. Amira Roess,
Ph.D., M.P.H. Epidemiologist, Project Researcher
Dr. John
Sandberg,
Ph.D., M.A. Demographer, Project Researcher
Dr. Carlos
Santos-Burgoa,
M.D., Ph.D., M.P.H. Epidemiologist, Principal Investigator
Dr. Scott Zeger,
Ph.D., M.S. (Johns Hopkins University, Bloomberg School of Public
Health) Biostatistician, Project Researcher and Expert Panel Member
Noel Estrada Merly,
M.S. Graduate Research Assistant, Project Research Assistant
Dr. Cruz María Nazario,
Ph.D. Epidemiologist, Project Researcher
Dr. Cynthia Pérez,
Ph.D. Epidemiologist, Project Researcher
Dr. Erick Suarez Pérez,
Ph.D., M.A. Biostatistician, Project Researcher
Ljubica Latinovic,
M.D., M.H.A. Communications Expert, Consultant
Ivonne Rivera,
M.P.H. Expert in Qualitative Analysis, Consultant
Samuel Clark,
Ph.D., M.A. Demographer
Debarati Guha Sapir,
Ph.D. Epidemiologist
Bernardo Hernández Prado,
DSc., M.S. Epidemiologist, Mortality Estimation Expert
Matthew Seeger,
Ph.D. Communications Expert
Daniel Hoffman,
Ph.D., M.P.H., Epidemiologist
Pietro Marghella,
DHSc, MSc, MA, CEM, FACCP Complex humanitarian emergencies expert
Sam Simmens,
Ph.D., M.A Biostatistician
Ronald Waldman,
M.D., M.P.H. Complex humanitarian emergencies expert ■
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