Keenan Olivia J, Soroka Orysya, Abramson David, Safford Monika, Shapiro Martin F, Ghosh Arnab K
Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, United States.
School of Global Public Health, New York University, New York, NY, United States.
Front Public Health. 2025 Aug 6;13:1523941. doi: 10.3389/fpubh.2025.1523941. eCollection 2025.
Hurricane-related flooding has long-term socioeconomic effects on impacted areas; however, little is known about the long-term health effects on vulnerable, older residents who remain in impacted neighborhoods. We examined mortality rates among older adults who continued living in ZIP Code Tabulation Areas (ZCTAs) impacted by flooding from Hurricane Sandy for up to 5 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 between matched flooded versus non-flooded ZCTAs for up to 5 years after Hurricane Sandy's landfall, among Medicare fee-for-service (FFS) beneficiaries aged 65 years and older who remained in the same ZCTA from 2013 to 2017. Adjusted mortality rate ratios (aMRR) were estimated for each region, controlling for ZCTA-level demographic and socioeconomic factors informed by the socioecological model of disaster recovery.
Before matching, compared to non-flooded ZCTAs, flooded ZCTAs had a higher average Area Deprivation Index (ADI) national rank (20.8 vs. 14.8) and a lower average median household income ($71,587 vs. $89,213). In the matched, adjusted analysis, the Medicare FFS beneficiaries who resided and remained in flood-impacted ZCTAs had a 9% higher risk of all-cause mortality up to 5 years after the event compared to the beneficiaries in ZCTAs not impacted by flooding (aMRR 1.09, 95% CI = 1.06-1.12). Adjusted mortality risk varied across geographic regions. In NYC, ZCTAs impacted by flooding had a significant 8% higher risk of long-term mortality up to 5 years after the event (aMRR 1.08, 95% CI = 1.02-1.15). CT also showed a significant 19% higher risk of long-term mortality up to 5 years (aMRR 1.19, 95% CI = 1.09-1.31). However, the results for NJ and NY were not significant (aMRR: 1.01, 95% CI = 0.97-1.06; aMRR: 0.96, 95% CI = 0.86-1.07).
ZCTAs impacted by hurricane-related flooding had higher rates of all-cause mortality up to 5 years after the event, but the magnitude of this effect varied by region. These findings highlight the lingering destructive impact of hurricane-related flooding on older adults and underscore the need for long-term, region-specific disaster planning.
与飓风相关的洪水对受灾地区具有长期的社会经济影响；然而，对于仍留在受灾社区的脆弱老年居民的长期健康影响却知之甚少。我们研究了在桑迪飓风登陆后长达5年的时间里，继续居住在受洪水影响的邮政编码分区统计区域（ZCTA）的老年人的死亡率。
我们在三州地区（纽约市[NYC]、纽约州除纽约市外[NY]、新泽西州[NJ]和康涅狄格州[CT]）对桑迪飓风过后进行了倾向得分匹配的ZCTA层面的生态分析。使用多变量模型，我们比较了桑迪飓风登陆后长达5年时间里，匹配的受洪水影响的ZCTA与未受洪水影响的ZCTA之间的全因死亡率，这些ZCTA中的医疗保险按服务收费（FFS）受益人为65岁及以上，且在2013年至2017年期间一直居住在同一ZCTA。根据灾难恢复的社会生态模型，对每个地区的ZCTA层面的人口和社会经济因素进行控制，估计调整后的死亡率比值（aMRR）。
在匹配之前，与未受洪水影响的ZCTA相比，受洪水影响的ZCTA的平均地区贫困指数（ADI）全国排名更高（20.8对14.8），平均家庭收入中位数更低（71,587美元对89,213美元）。在匹配的调整分析中，居住并留在受洪水影响的ZCTA的医疗保险FFS受益人在事件发生后长达5年的时间里，全因死亡风险比未受洪水影响的ZCTA中的受益人高9%（aMRR 1.09，95%置信区间=1.06 - 1.12）。调整后的死亡风险因地理区域而异。在纽约市，受洪水影响的ZCTA在事件发生后长达5年的时间里，长期死亡风险显著高8%（aMRR 1.08，95%置信区间=1.02 - 1.15）。康涅狄格州在长达5年的时间里也显示出长期死亡风险显著高19%（aMRR 1.19，95%置信区间=1.09 - 1.31）。然而，新泽西州和纽约州的结果不显著（aMRR：1.01，95%置信区间=0.97 - 1.06；aMRR：0.96，95%置信区间=0.86 - 1.07）。
受飓风相关洪水影响的ZCTA在事件发生后长达5年的时间里全因死亡率较高，但这种影响的程度因地区而异。这些发现凸显了飓风相关洪水对老年人持续存在的破坏性影响，并强调了针对特定地区制定长期灾难规划的必要性。
