scholarly journals Use of Death Counts From Vital Statistics to Calculate Excess Deaths in Puerto Rico Following Hurricane Maria

JAMA ◽  
2018 ◽  
Vol 320 (14) ◽  
pp. 1491 ◽  
Author(s):  
Alexis R. Santos-Lozada ◽  
Jeffrey T. Howard
Keyword(s):  
Puerto Rico ◽  
Vital Statistics ◽  
Excess Deaths

scholarly journals Estimates of excess deaths in Puerto Rico following Hurricane Maria

2017 ◽  
Author(s):  
Alexis R Santos ◽  
Jeffrey T. Howard
Keyword(s):  
Puerto Rico ◽  
Confidence Intervals ◽  
Public Safety ◽  
Vital Statistics ◽  
Aggregated Data ◽  
Estimation Techniques ◽  
Death Toll ◽  
Mortality Burden ◽  
The Difference ◽  
Excess Deaths

BACKGROUND: This descriptive finding examines excess deaths following Hurricane María, in Puerto Rico for September and October 2017. OBJECTIVE: We seek to determine the degree of excess deaths in Puerto Rico based on historical patterns of variability in deaths by month for the 2010-2016 period and using estimation techniques. METHODS: Data for this study come from death records from the Puerto Rico Vital Statistics system. We aggregated data by month and year (2010-2016) and produced means (expected deaths) and 95% confidence intervals (C.I., or patterns of variability) for each month. Using public statements from the Puerto Rico Department of Public Safety, we estimate the number of deaths for September and October 2017 and compare it to the level of expected deaths considering the pattern of variability. RESULTS: Expected deaths for September and October were 2,383 (95% C.I. 2,296-2,469) and 2,428 (95% C.I. 2,380 - 2,476), respectively. Estimates for total deaths, for September and October 2017 were 2,987 (95% CI 2,900-3,074) and 3,043 (95% C.I. 2,995-3,091), respectively. The difference between our estimates and the upper 95% CI for the average deaths is 518 deaths for September and 567 deaths for October. CONCLUSIONS: The mortality burden may higher than official counts, and may exceed the current official death toll by a factor of 10 or more.

scholarly journals Evaluation of death count estimates for Puerto Rico following Hurricane Maria

2018 ◽  
Author(s):  
Alexis R Santos ◽  
Jeffrey T. Howard
Keyword(s):  
Puerto Rico ◽  
Incomplete Information ◽  
Confidence Intervals ◽  
Vital Statistics ◽  
Initial Estimate ◽  
Excess Death ◽  
Estimation Process ◽  
Climate Disasters ◽  
Death Count ◽  
Excess Deaths

This descriptive finding examines estimates of death counts following Hurricane Maria in Puerto Rico for September and October 2017. We evaluate the monthly death count estimates and estimates of excess deaths in Puerto Rico based on historical patterns of variability by month for the 2010-2016 and published official death counts for 2017. Official death records from the Puerto Rico Vital Statistics Systems by month and year (2010-2016) were used to produce means and 95% confidence intervals (95% C.I.) for each month. Death count and excess death estimates for September and November 2017 are employed to: (1) illustrate the estimation process and (2) assess the accuracy of these estimates when compared to official death counts for the same period. Estimates produced with incomplete information were 2,987 (95% C.I. 2,900-3,074) and 3,043 (95% C.I. 2,995-3,091) for September and October 2017, respectively. Corresponding official death counts for the same months for 2017 were 2,928 and 3,040. Using estimated death counts, 1,085 excess deaths (95% C.I. 950-1,220) were estimated in November 2017. Using official counts yielded 1,023 excess deaths (95% C.I. 956-1,090). Despite initially overestimating the number of deaths in September and October by 1.04%, subsequent estimate of excess deaths using official death counts was within the 95% C.I. of the initial estimate. Our findings demonstrate the timely production of death count estimates following climate disasters using historical death records and a thorough study of previous experiences.

scholarly journals Leveraging online repositories: the case of excess deaths following Hurricane Maria in Puerto Rico

2018 ◽  
Author(s):  
Alexis R Santos
Keyword(s):  
Puerto Rico ◽  
Vital Statistics ◽  
Data Repository ◽  
Working Paper ◽  
Excess Deaths

This working paper describes the process through which I created, developed and improved a data repository for data and code used to replicate our paper titled "Use of Death Counts from Vital Statistics to Calculate Excess Deaths in Puerto Rico Following Hurricane Maria". The repository can be accessed here: https://alexisrsantos.github.io/Deaths_Puerto_Rico_JAMA/. It also documents the opportunities and challenges of engaging in this endeavor.

scholarly journals Quantifying inequities in US federal response to hurricane disaster in Texas and Florida compared with Puerto Rico

2019 ◽  
Vol 4 (1) ◽  
pp. e001191 ◽  
Author(s):  
Charley E Willison ◽  
Phillip M Singer ◽  
Melissa S Creary ◽  
Scott L. Greer
Keyword(s):  
Puerto Rico ◽  
Federal Government ◽  
Critical Time ◽  
Vital Statistics ◽  
Federal Spending ◽  
Storm Damage ◽  
Adverse Health Outcomes ◽  
News Releases ◽  
Insufficient Response ◽  
Federal Response

If disaster responses vary in their effectiveness across communities, health equity is affected. This paper aims to evaluate and describe variation in the federal disaster responses to 2017 Hurricanes Harvey, Irma and Maria, compared with the need and severity of storm damage through a retrospective analysis. Our analysis spans from landfall to 6 months after landfall for each hurricane. To examine differences in disaster responses across the hurricanes, we focus on measures of federal spending, federal resources distributed and direct and indirect storm-mortality counts. Federal spending estimates come from congressional appropriations and Federal Emergency Management Agency (FEMA) records. Resource estimates come from FEMA documents and news releases. Mortality counts come from National Oceanic and Atmospheric Administration (NOAA) reports, respective vital statistics offices and news articles. Damage estimates came from NOAA reports. In each case, we compare the responses and the severity at critical time points after the storm based on FEMA time logs. Our results show that the federal government responded on a larger scale and much more quickly across measures of federal money and staffing to Hurricanes Harvey and Irma in Texas and Florida, compared with Hurricane Maria in Puerto Rico. The variation in the responses was not commensurate with storm severity and need after landfall in the case of Puerto Rico compared with Texas and Florida. Assuming that disaster responses should be at least commensurate to the degree of storm severity and need of the population, the insufficient response received by Puerto Rico raises concern for growth in health disparities and increases in adverse health outcomes.

scholarly journals In Puerto Rico, excess deaths following Hurricane Georges persisted for three months

2018 ◽  
Author(s):  
Alexis R Santos
Keyword(s):  
Puerto Rico ◽  
Upper Limit ◽  
The World ◽  
Basic Services ◽  
Drinkable Water ◽  
Population Shift ◽  
Climate Disasters ◽  
Death Count ◽  
Climate Disaster ◽  
Excess Deaths

The interruption in basic services such as electricity, drinkable water, and exposure to atypical circumstances following climate disasters increases mortality risk within the settings affected by these events. Recently, some members of academia have argued that no methodology exists to study excess deaths attributable to climate disasters. This study uses death records for Puerto Rico between 1990 and 1998 to assess excess deaths following Hurricane Georges by comparing death counts for 1998 with patterns of variation from the previous eight years. Because no population shift occurred in that decade, other than expected ones based on historical information, the average number of deaths is indicative of expected deaths and the confidence intervals are the ranges of accepted variation. If a count following a climate disaster exceeds the upper limit of the confidence interval these deaths could be considered above the historical ranges of variation and this excess could be associated with the climate disaster of interest. Death counts for September-November 1998 indicate that 819 deaths were in excess of historical ranges of variation. When the year in which Hurricane Hortense is excluded from the construction of the ranges of variation, the excess is 945 deaths. A total of 811 or 937 are missing in comparison to the official death count for this Hurricane. Considering that death counts data structures are comparable across the countries of the world, this method can be used to analyze the effect of other climate disasters.

Excess Deaths After Hurricane Maria in Puerto Rico—Reply

JAMA ◽  
2019 ◽  
Vol 321 (10) ◽  
pp. 1005 ◽  
Author(s):  
Alexis R. Santos-Lozada ◽  
Jeffrey T. Howard
Keyword(s):  
Puerto Rico ◽  
Excess Deaths

scholarly journals Lessons learned and lessons missed: impact of the coronavirus disease 2019 (COVID-19) pandemic on all-cause mortality in 40 industrialised countries prior to mass vaccination

2021 ◽  
Vol 6 ◽  
pp. 279
Author(s):  
Vasilis Kontis ◽  
James E. Bennett ◽  
Robbie M. Parks ◽  
Theo Rashid ◽  
Jonathan Pearson-Stuttard ◽  
...  
Keyword(s):  
Probabilistic Models ◽  
Great Majority ◽  
Credible Interval ◽  
Vital Statistics ◽  
Lessons Learned ◽  
All Cause Mortality ◽  
The Usa ◽  
Industrialised Countries ◽  
Substantial Heterogeneity ◽  
Excess Deaths

Background: Industrialised countries had varied responses to the coronavirus disease 2019 (COVID-19) pandemic, and how they adapted to new situations and knowledge since it began. These differences in preparedness and policy may lead to different death tolls from COVID-19 as well as other diseases. Methods: We applied an ensemble of 16 Bayesian probabilistic models to vital statistics data to estimate the impacts of the pandemic on weekly all-cause mortality for 40 industrialised countries from mid-February 2020 through mid-February 2021, before a large segment of the population was vaccinated in these countries. Results: Over the entire year, an estimated 1,410,300 (95% credible interval 1,267,600-1,579,200) more people died in these countries than would have been expected had the pandemic not happened. This is equivalent to 141 (127-158) additional deaths per 100,000 people and a 15% (14-17) increase in deaths in all these countries combined. In Iceland, Australia and New Zealand, mortality was lower than would be expected if the pandemic had not occurred, while South Korea and Norway experienced no detectable change in mortality. In contrast, the USA, Czechia, Slovakia and Poland experienced at least 20% higher mortality. There was substantial heterogeneity across countries in the dynamics of excess mortality. The first wave of the pandemic, from mid-February to the end of May 2020, accounted for over half of excess deaths in Scotland, Spain, England and Wales, Canada, Sweden, Belgium, the Netherlands and Cyprus. At the other extreme, the period between mid-September 2020 and mid-February 2021 accounted for over 90% of excess deaths in Bulgaria, Croatia, Czechia, Hungary, Latvia, Montenegro, Poland, Slovakia and Slovenia. Conclusions: Until the great majority of national and global populations have vaccine-acquired immunity, minimising the death toll of the pandemic from COVID-19 and other diseases will require actions to delay and contain infections and continue routine health care.

THE TOLL OF INEQUALITY

2019 ◽  
Vol 16 (2) ◽  
pp. 291-340
Author(s):  
Mary R. Jackman ◽  
Kimberlee A. Shauman
Keyword(s):  
Twentieth Century ◽  
Black Women ◽  
African Americans ◽  
Racial Inequality ◽  
The United States ◽  
Mortality Rates ◽  
Vital Statistics ◽  
Policy Implications ◽  
Racial Gap ◽  
Excess Deaths

AbstractTo take stock of the human toll resulting from racial inequality in the United States, we estimate the number of excess deaths that accumulated among African Americans over the twentieth century as a result of the enduring racial gap in mortality rates. We assemble a wide array of demographic and vital statistics data for all years since 1900 to calculate the number of Black deaths in each half-decade that occurred in excess of what would be projected if Blacks had experienced the same gender- and age-specific mortality rates as Whites. We estimate that there were almost 7.7 million excess deaths among African Americans from 1900 through 1999. Those deaths comprised over 40% of all African American deaths over the century.Excess deaths were highest in the early decades (peaking in 1925–1934), but the only period of sustained decline was 1935–1949. Subsequent reductions in excess deaths were relatively modest and unstable, and in the last decade of the century the percentage of Blacks’ deaths that were excess returned to levels as high as in the first decade. That trajectory is less positive than the trajectory for the racial gap in life expectancy over the century.Excess deaths fell disproportionately among the young in the early twentieth century, but in the succeeding decades they progressively hit harder among older African Americans, many of them in the prime of life when their economic and social pursuits were vital to their families and communities. Excess deaths were also especially heavy among Black women for most of the century.We conclude by discussing the social and policy implications of the excess deaths. We assess trends in the early twenty-first century as we consider the political challenges involved in tackling the continuing excess death toll.

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