Long-term impacts of hurricanes on mortality in Medicare beneficiaries: Evidence from Hurricane Sandy

Olivia J. Keenan¹Orysya Soroka¹David Abramson²Monika Safford¹Martin F. Shapiro¹Arnab K. Ghosh^1*

• ¹Weill Cornell Medicine, Cornell University, New York, United States
• ²School of Global Public Health, New York University, New York, New York, United States

Objectives: Hurricane-related flooding has long-term socioeconomic effects on impacted areas; however, little is known about longer term health effects of vulnerable, older-aged residents who stay in impacted neighborhoods. We examine mortality rates for older adults who remained in ZIP Code Tabulation Areas (ZCTAs) impacted by flooding from Hurricane Sandy up to five years after landfall.: We conducted a propensity-score matched ZCTA-level ecological analysis post-Hurricane Sandy across the tri-state area (New York City [NYC], New York state excluding NYC [NY], New Jersey [NJ], and Connecticut [CT]). Using multivariable models, we compared all-cause mortality rates within matched flooded vs non-flooded ZCTAs matched up to five years after Hurricane Sandy's landfall for Medicare Fee-for-service (FFS) beneficiaries over 65 years who stayed in the same ZCTA from 2013 to 2017. Adjusted Mortality Rate Ratios (aMRR) were conducted within each region and adjusted for ZCTA-level demographic and socioeconomic factors informed by the socioecological model of disaster recovery. Results: Before matching, compared to non-flooded ZCTAs, flooded ZCTAs had a higher average ADI national rank (20.8 vs 14.8) and on average lower median household income ($71,587 vs $89,213). In the matched, adjusted analysis, Medicare FFS beneficiaries who resided and remained in flood-impacted ZCTAs had a significant 9% higher risk of all-cause mortality up to five years after the event compared to beneficiaries in ZCTAs not impacted by flooding (aMRROVERALL 1.09, 95% CI = 1.06-1.12). Adjusted mortality risk varied between geographic regions. NYC ZCTAs impacted by flooding had a significant 8% higher risk of long-term mortality up to five years (aMRRNYC 1.08, 95% CI = 1.02-1.15). CT also showed a significant 19% higher risk of long-term mortality up to five years (aMRRCT 1.19, 95% CI = 1.09-1.31). However, results for NJ and NY were not significant (aMRRNJ: 1.01, 95% CI = 0.97-1.06; aMRRNY: 0.96, 95% CI = 0.86-1.07).Conclusions: ZCTAs impacted by hurricane-related flooding had higher rates of all-cause mortality up to five years after the event, but the effect varied by region. These findings highlight the lingering destructive impact of hurricane-related flooding among older adults and underscore the need for long-term, region-specific disaster planning.