Estimates of Excess Deaths and Reported Causes of Death in Puerto Rico caused by Hurricane Maria. Panel A shows a comparison of estimates of excess deaths from official reports, press (New York Times) and academic (Santos–Lozada and Howard) reports, and from our survey. Panel B shows deaths according to the month of death and the age at death as reported in our survey, categorized according to the cause of death reported by the household member. Two persons who died of similar causes at the same age are represented by dots that are superimposed in December; thus, the 37 points shown represent 38 deaths after the hurricane. Graphic:  Kishore, et al., 2018 / The New England Journal of Medicine

29 May 2018 (BBC News) – Hurricane Maria killed more than 4,600 people in Puerto Rico, 70 times the official toll, according to estimates in a Harvard University study.

A third of deaths after September's hurricane were due to interruptions in medical care caused by power cuts and broken road links, researchers say.

Interviews conducted in Puerto Rico suggest a 60% increase in mortality in the three months after the storm.

The official death toll currently stands at 64.

But experts say an accurate count was complicated by the widespread devastation wreaked by the storm.

The Harvard researchers contacted more than 3,000 randomly selected households between January and March this year and asked about displacement, infrastructure loss and causes of death.

They then compared their results with the official mortality rates for the same period in 2016, more than a year before the hurricane struck the island.

The researchers said that interrupted medical care was the "primary cause of sustained high mortality rates in the months after the hurricane". [more]

Hurricane Maria 'killed 4,600 in Puerto Rico'

ABSTRACT: Quantifying 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.


Using 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.


From 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.


This 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. (Funded by the Harvard T.H. Chan School of Public Health and others.)

Mortality in Puerto Rico after Hurricane Maria



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