Tropical Storms and Associated Risk to All-Cause, Accidental, Cardiovascular, and Respiratory Mortality in 78 United States Communities, 1988-2005

摘要

While risks of accidental deaths from tropical storms (e.g., drowning, carbon monoxide poisoning) have been well-documented, much less is known about risks for more common causes of mortality (e.g., cardiovascular, respiratory). Here, we conducted the first multi-year, multi-state epidemiological study to estimate the relative risks (RRs) of community-wide allcause, cardiovascular, respiratory, and accidental mortality associated with tropical storm exposure in the United States (US). To measure storm exposure, we used five hazard-related metrics-distance to storm track; cumulative rainfall; maximum sustained wind speed; flooding; and tornadoes. For each exposure metric, we modeled the association between community-level storm exposure and daily death counts in 78 large eastern US communities, 1988-2005, using a matched analysis of storm-exposed days versus similar unexposed days. We assessed risks for a window from two days before to seven days after the storm's closest approach. Over the study period, 92 Atlantic Basin tropical storms were considered based on US landfall or near-approach, with 70 communities exposed to at least one storm. Under windbased exposure metrics, we found substantially elevated risk for all mortality outcomes considered, with highest risk typically on the day the storm was closest. Based on windexposure, overall RRs of mortality during the full storm exposure window were 1.90 (95% CI: 1.58-2.29), 161.41 (61.62-422.80), 1.30 (0.97-1.76), 1.54 (0.70-3.39) for all-cause, accidental, cardiovascular, and respiratory mortality, respectively. These estimated associations may be dominated by extremely high risks during the few most severe storms (e.g., Andrew [1992], Katrina [2005]), a hypothesis we continue to explore. Our results suggest that very severe tropical storm exposures can have important mortality impacts beyond direct accidental deaths, including potentially important risks for cardiovascular and respiratory mortality.