Displacement and Mortality After a Disaster: Deaths of Puerto Ricans in the United States Post-Hurricane Maria

Extreme weather events such as hurricanes are growing in frequency and magnitude and are expected to affect a growing population due to migration patterns, ecosystem alteration, and climate. While all victims of natural disasters face common challenges, displaced populations undergo distinct experiences that are specific to their relocation. However, measuring the mortality consequences of disasters among these populations is inherently challenging due to the displacement that can take place before, during or in the aftermath of an event. We use an interrupted time-series design to analyze all-cause mortality of Puerto Ricans in the U.S. to determine death occurrences of Puerto Ricans on the mainland U.S. following the arrival of Hurricane Maria in Puerto Rico in September 2017. Hispanic Origin data from the National Vital Statistics System and from the Public Use Microdata Sample of the American Community Survey are used to estimate monthly origin-specific mortality rates for the period 2012 to 2018. We estimated log-linear regressions of monthly deaths of persons of Puerto Rican vs. other Hispanic groups by age group, gender, and educational attainment. We found an increase in mortality for persons of Puerto Rican origin during the 6-month period following the Hurricane (October 2017 through March 2018), suggesting that deaths among these persons were 3.7% (95% CI: 0.025-0.049) higher than would have otherwise been expected. In absolute terms, we estimated 514 excess deaths (95% CI 346 – 681) of persons of Puerto Rican origin that occurred on the mainland U.S., concentrated in those aged 65 years or older. Our findings suggest an undercounting of previous deaths as a result of the hurricane due to the systematic effects on the displaced and resident population in the mainland U.S. Displaced populations are frequently overlooked in disaster relief and subsequent research. Ignoring these populations provides an incomplete understanding of the damages and loss of life.