Puerto Rico (The United States of America)

Ascertainment of the estimated excess mortality from Hurricane Maria in Puerto Rico

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This study assesses excess total mortality due to Hurricane Maria in Puerto Rico, adjusting for demographic variables and seasonality; evaluates the implementation of Centers for Disease Control and Prevention (CDC) guidelines for mortality reporting in disasters; and assesses crisis and mortality communication plans and actions by the Puerto Rico government. It makes recommendations for improved policy and practice in mortality surveillance and crisis and mortality communications in disasters.

This study finds that total excess mortality post-hurricane using the migration displacement scenario is estimated to be 2,975 (95% CI: 2,658-3,290) for the total study period of September 2017 through February 2018. The results of the analysis of total excess mortality by socio-demographic subgroups show that every social stratum and age group was affected by excess mortality. However, the impact differed by age and socioeconomic status. The risk of death was 45% higher and persistent until the end of the study period for populations living in low socioeconomic development municipalities, and older males (65+) experienced continuous elevated risk of death through February. Overall, this report estimates that 40% of municipalities experienced significantly higher mortality in the study period than in the comparable period of the previous two years.

This study shows that physician lack of awareness of appropriate death certification practices after a natural disaster and the Government of Puerto Rico’s lack of communication about death certificate reporting prior to the 2017 hurricane season limited the count of deaths that were reported as related to Hurricane María.

The study also found inadequate preparedness and personnel training for crisis and emergency risk communication. Combined with numerous barriers to accurate, timely information and factors that increased rumor generation, the lack of preparedness and training ultimately decreased the perceived transparency and credibility of the Government of Puerto Rico.