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Floods and cause-specific mortality in the United States applying a triply robust approach

Author

Listed:
  • Lingzhi Chu

    (Yale School of Public Health
    Yale School of Public Health)

  • Joshua L. Warren

    (Yale School of Public Health)

  • Erica S. Spatz

    (Yale-New Haven Hospital
    Yale School of Medicine)

  • Sarah Lowe

    (Yale School of Public Health)

  • Yuan Lu

    (Yale-New Haven Hospital
    Yale School of Medicine
    Yale School of Public Health
    Yale School of Medicine)

  • Xiaomei Ma

    (Yale School of Public Health
    and Effectiveness Research Center)

  • Joseph S. Ross

    (Yale-New Haven Hospital
    Yale School of Medicine
    Yale School of Public Health)

  • Harlan M. Krumholz

    (Yale-New Haven Hospital
    Yale School of Medicine
    Yale School of Public Health)

  • Kai Chen

    (Yale School of Public Health
    Yale School of Public Health)

Abstract

The health impact of floods has not been well characterized. This study evaluated long-term associations between cause-specific mortality rates and county-level monthly flood days (excluding coastal floods caused by tropical storms) in the post-flood year in the contiguous U.S., using a triply robust approach incorporating propensity score, counterfactual estimation, and confounder adjustment. Death records came from the CDC National Center for Health Statistics (2001-2020) and floods came from the NOAA Storm Events Database (2000-2020). We found that one flood day was associated with 8.3 (95% CI: 2.5 to 14.1) excess all-cause deaths per 10 million individuals, 3.1 due to myocardial infarction, 2.4 due to respiratory diseases, and 5.9 due to external causes. From 2001 to 2020, 22,376 (95% CI: 6,758 to 37,993) all-cause deaths were attributable to floods. Our findings highlight the long-term health risks after floods, and a need for measures to reduce these risks.

Suggested Citation

  • Lingzhi Chu & Joshua L. Warren & Erica S. Spatz & Sarah Lowe & Yuan Lu & Xiaomei Ma & Joseph S. Ross & Harlan M. Krumholz & Kai Chen, 2025. "Floods and cause-specific mortality in the United States applying a triply robust approach," Nature Communications, Nature, vol. 16(1), pages 1-9, December.
    • Handle: RePEc:nat:natcom:v:16:y:2025:i:1:d:10.1038_s41467-025-58236-0
    DOI: 10.1038/s41467-025-58236-0
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    References listed on IDEAS

    as
    1. Yiqun Ma & Emma Zang & Ijeoma Opara & Yuan Lu & Harlan M. Krumholz & Kai Chen, 2023. "Racial/ethnic disparities in PM2.5-attributable cardiovascular mortality burden in the United States," Nature Human Behaviour, Nature, vol. 7(12), pages 2074-2083, December.
    2. Hamid R. Oskorouchi & Alfonso Sousa‐Poza, 2021. "Floods, food security, and coping strategies: Evidence from Afghanistan," Agricultural Economics, International Association of Agricultural Economists, vol. 52(1), pages 123-140, January.
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