Mortality in Puerto Rico after Hurricane Maria
Mortality in Puerto Rico after Hurricane Maria
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DOI：
10.1056/nejmsa1803972
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发表时间：
2018-07-12
影响因子：
158.5
通讯作者：
Buckee, Caroline O.
中科院分区：
文献类型：
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作者：
Kishore, Nishant;Marques, Domingo;Buckee, Caroline O.
量化自然灾害对社会的影响对于公共卫生服务和基础设施的恢复至关重要。在重大灾难发生后，死亡人数可能难以估计。2017年9月，飓风玛丽亚对波多黎各造成了大规模的基础设施破坏，但其对死亡率的影响仍然存在争议。官方的死亡人数为64人。方法：我们采用具有代表性的分层样本，对波多黎各随机选择的3299户家庭进行调查，对飓风后的全因死亡率进行独立估计。受访者被问及流离失所、基础设施损失和死亡原因。我们通过将我们估计的飓风后死亡率与2016年同期的官方死亡率进行比较来计算超额死亡人数。根据调查数据，我们估计2017年9月20日至12月31日的死亡率为每1000人14.3人（95%置信区间[CI]，9.8至18.9）。这一比率在此期间产生了4645例额外死亡（95%CI，793至8498），相当于死亡率与2016年同期相比增加了62%。然而，由于幸存者偏见，这一数字可能被低估。截至2017年12月底，死亡率仍然很高，三分之一的死亡归因于医疗服务的延误或中断。飓风相关的移民是substantial.CONCLUSIONSThis以家庭为基础的调查表明，在波多黎各与飓风玛丽亚有关的超额死亡人数是官方估计的70倍以上。
BACKGROUNDQuantifying the effect of natural disasters on society is critical for recovery of public health services and infrastructure. The death toll can be difficult to assess in the aftermath of a major disaster. In September 2017, Hurricane Maria caused massive infrastructural damage to Puerto Rico, but its effect on mortality remains contentious. The official death count is 64.METHODSUsing a representative, stratified sample, we surveyed 3299 randomly chosen households across Puerto Rico to produce an independent estimate of all-cause mortality after the hurricane. Respondents were asked about displacement, infrastructure loss, and causes of death. We calculated excess deaths by comparing our estimated post-hurricane mortality rate with official rates for the same period in 2016.RESULTSFrom the survey data, we estimated a mortality rate of 14.3 deaths (95% confidence interval [CI], 9.8 to 18.9) per 1000 persons from September 20 through December 31, 2017. This rate yielded a total of 4645 excess deaths during this period (95% CI, 793 to 8498), equivalent to a 62% increase in the mortality rate as compared with the same period in 2016. However, this number is likely to be an underestimate because of survivor bias. The mortality rate remained high through the end of December 2017, and one third of the deaths were attributed to delayed or interrupted health care. Hurricane-related migration was substantial.CONCLUSIONSThis household-based survey suggests that the number of excess deaths related to Hurricane Maria in Puerto Rico is more than 70 times the official estimate.