Background:
In September 2017, Hurricane Maria devastated Puerto Rico (PR), in what is now regarded as one of the worst natural disasters in United States (US) history. Natural disasters can impact health directly as well as indirectly through their impacts on health behavior, health utilization, and migration. Population-based estimates of the health of PR residents before and after Hurricane Maria have not been assessed.
Objective:
The overall goal of this project is to compare key health indicators, particularly cardiovascular disease risk factors, among PR residents pre- and post-Hurricane Maria.
Methods:
This study used data from the Behavioral Risk Factor Surveillance System (BRFSS) in PR. We included data from four survey years: 2015 (N=4556), 2016 (N=5765), 2017 (N=4462), and 2018 (N=4814). The sample consisted of non-institutionalized adults age ≥18 years with access to a landline or a cellular telephone. Since BRFSS data collection in PR were completed in the Spring, and Hurricane Maria struck in Fall 2017, we analyzed three yearsof pre-hurricane data (2015, 2016, 2017) and one year post-hurricane (2018). We will soon be including a second year of data post-hurricane (2019). We used logistic regression analyses to compare health care utilization (health insurance coverage, routine checkup within past year), health behaviors (alcohol use, smoking), and health outcomes (obesity, diabetes, depression) pre- and post-Hurricane Maria. Survey year 2017 was the referent in all models. Final models were adjusted for age, sex, race, education, employment, income, and marital status.
Results:
Compared to survey year 2017, in 2018 (post-hurricane) participants were more likely to have a college degree or higher, be currently employed, and not married/partnered. Post-hurricane, participants were less likely to have health insurance coverage (AOR, 95% CI: 0.75, 0.58-0.97) and had lower rates of diabetes (AOR: 0.82, 0.70-0.96). The odds of being overweight/obese were lower in 2015 (pre-hurricane) compared to 2017 (AOR, 95% CI: 0.88, 0.79-0.97). There was no significant difference in health behaviors across survey years.
Conclusions:
Participants who completed the BRFSS in PR post-Hurricane Maria had a higher socioeconomic status and lower rates of diabetes. Our results may suggest that PR residents with a lower socioeconomic status and/or chronic illness were more likely to emigrate, resulting in a compositional change in the population post-hurricane. This analysis highlights the need for long-term follow-up of PR residents to better determine the impact of Hurricane Maria, and adequately design public health programs to address healthcare needs, access, and outcomes.
Health insurance coverage and contraceptive use at the state level: findings from the 2017 Behavioral Risk Factor Surveillance System