International Journal of Biometeorology

, Volume 55, Issue 4, pp 533–546 | Cite as

Direct and indirect mortality in Florida during the 2004 hurricane season

  • Nathan McKinney
  • Chris HouserEmail author
  • Klaus Meyer-Arendt
Original Paper


Previous studies have shown that natural disasters, and hurricanes in particular, have led to more deaths than those usually documented in short post-storm surveys. Such indirect deaths, thought to be related to dietary, stress or pre-existing medical conditions, can exceed the number of direct deaths and may persist for weeks or even months beyond the event itself. In the present study, cumulative sum of deviations plots are used to quantify the number of direct and indirect deaths resulting from Hurricanes Charley, Frances, Ivan and Jeanne that made landfall in Florida in 2004. Results suggest that there was an elevated mortality for up to 2 months following each storm, resulting in a total of 624 direct and indirect deaths attributable to the storm. Trauma-related deaths that can be associated directly with the storm account for only ∼4% of the total storm-related mortality, while indirect mortality accounts for most storm-related deaths. Specifically, a large percentage of the elevated mortality was associated with heart (34%) and cancer-related deaths (19%), while diabetes (5%) and accident-related deaths (9%) account for a smaller but still significant percentage of the elevated mortality. The results further suggest that the elevated mortality was the result of additional deaths that would not have otherwise occurred within that 5 month period, and not simply a clustering of deaths that were inevitable between 1 August and 31 December 2004. The elevated mortality identified in this study is significantly greater than the official count of 31 direct and 113 indirect deaths resulting from the four hurricanes combined. This suggests a need for improved mortality counts and surveillance in order to better evaluate and identify effective prevention policies, and to identify preventable deaths.


Hurricane Mortality Direct and indirect death 



Funding for this study was provided from the National Weather Service Program Office (Award Number NA04NWS4680010) through the Florida Hurricane Alliance Research Program led by Stephen Leatherman of Florida International University.


  1. Abramson D, Stehling-Ariza T, Garfield R, Redlener I (2008) Prevalence and predictors of mental health distress post-Katrina: Findings from the Gulf Coast child and family health study. Disaster Med Public Health Prep 2:77–86CrossRefGoogle Scholar
  2. Armenian HK, Melkonian AK, Hovanesian AP (1998) Long term mortality and morbidity related to degree of damage following the 1988 earthquake in Armenia. Am J Epidemiol 148(11):1077–1084Google Scholar
  3. Arguez A, Elsner JB (2001) Trends in US tropical cyclone mortality during the 20th century. Florida Geographer 32:28–37Google Scholar
  4. Baxter PJ, Möller I, Spencer T, Spence RJ, Tapsell S (2001) Flooding and climate change. Health effects of climate change. Section 4.6. UK Department of Health DocumentGoogle Scholar
  5. Bennet G (1970) Bristol floods 1968—controlled survey disaster. BMJ 3:454–458.Google Scholar
  6. Blake ES, Rappaport EN, Landsea CW (2007) The deadliest, costliest, and most intense United States tropical cyclones from 1851 to 2006 (and other frequently requested hurricane facts). US Department of Commerce, National Weather Service, National Hurricane Center, Miami, FL. NOAA Technical Memorandum TPC-5.
  7. Borden KA, Cutter SL (2008) Spatial patterns of natural hazards mortality in the United States. Int J Health Geogr 7(64):1–13. doi: 10.1186/1476-072X-7_64 Google Scholar
  8. Bourque LB, Siegel JM, Kano M, Wood MM (2006) Weathering the storm: The impact of hurricanes on physical and mental health. Ann Am Acad Polit Soc Sci 604:129–151CrossRefGoogle Scholar
  9. Cardona OD (2003) The need for rethinking the concepts of vulnerability and risk from an holistic perspective: a necessary review and criticism for effective risk management. In: Bankoff G, Frerks G, Hilhorst D (eds) Mapping vulnerability: disasters, development and people. Earthscan, London, pp 37–51Google Scholar
  10. CDC (2004) Rapid assessment of the needs and health status of older adults after Hurricane Charley- Charlotte, DeSoto, and Hardee counties, Florida, August 27–31, 2004. MMWR 36:837–840Google Scholar
  11. Combs DL, Parrish RG, McNabb SJN, Davis JH (1996) Deaths related to Hurricane Andrew in Florida and Louisiana, 1992. Int J Epidemiol 25(3):537–544CrossRefGoogle Scholar
  12. Combs DL, Quenomoen LE, Parrish RG, Davis JH (1999) Assessing disaster-attributed mortality: development and application of a definition and classification matrix. Int J Epidemiol 28:1124–1129CrossRefGoogle Scholar
  13. Davis RE, Knappenberger PC, Michaels PJ, Novicoff WM (2003) Changing heat-related mortality in the United States. Environ Health Perspect 111(14):1712–1718CrossRefGoogle Scholar
  14. Dominici F, Levy JI, Louis TA (2005) Methodological challenges and contributions in disaster epidemiology. Epidemiol Rev 27:9–12CrossRefGoogle Scholar
  15. Fayard GM (2009) Fatal work injuries involving natural disasters, 1992–2006. Disaster Med Public Health Prep 3:201–209CrossRefGoogle Scholar
  16. Florida Office of Economic & Demographic Research (2010) Population Based Information.
  17. Forrester MB (2009) Impact of Hurricane Ike on Texas Poison Control Center Calls. Disaster Med Public Health Prep 3:136–137CrossRefGoogle Scholar
  18. Galea S, Nandi A, Vlahov D (2005) The epidemiology of post-traumatic stress disorder after disasters. Epidemiol Rev 27:78–91CrossRefGoogle Scholar
  19. Gautam S, Menachem J, Srivastav SK, Delafontaine P, Irimpen A (2009) Effect of Hurricane Katrina on the incidence of acute coronary syndrome at a primary angioplasty center in New Orleans. Disaster Med Public Health Prep 3:144–150CrossRefGoogle Scholar
  20. Grubb F (1969) Procedures for detecting outlying observations in samples. Technometrics 11:1–21CrossRefGoogle Scholar
  21. Hendrickson LA, Vogt RL (1996) Mortality of Kauai residents in the 12-month period following Hurricane Iniki. Am J Epidemiol 144(2):188–191Google Scholar
  22. Jani AA, Fierro M, Kiser S, Ayala-Simms V, Darby DH, Juenker S, Storey R, Reynolds C, Marr J, Miller G (2006) Hurricane Isabel-related mortality—Virginia, 2003. J Public Health Manage Pract 12:97–102Google Scholar
  23. Jonkman SN, Kelman I (2005) An analysis of the causes and circumstances of flood disaster deaths. Disasters 29:75–97CrossRefGoogle Scholar
  24. Joseph DA, Wingo PA, King JB, Pollack LA, Richardson LC, Wu X, Chen V, Austin HD, Rogers D, Cook J (2009) Use of state cancer surveillance data to estimate the cancer burden in disaster affected areas- Hurricane Katrina, 2005. Prehosp Disaster Med 22:282–290Google Scholar
  25. Kalkstein LS, Davis RE (1989) Weather and human mortality: An evaluation of demographic and interregional responses in the United States. Ann Assoc Am Geogr 79(1):44–64CrossRefGoogle Scholar
  26. Kates RW, Colten CE, Laska S, Leatherman SP (2006) Reconstruction of New Orleans after Hurricane Katrina: a research perspective. Proc Natl Acad Sci USA 103(40):14653–14660CrossRefGoogle Scholar
  27. Kelman I (2004) Philosophy of flood fatalities. FloodRiskNet Newsletter 1:3–4Google Scholar
  28. Knabb RD, Rhome JR, Brown DP (2006) Tropical Cyclone Report: Hurricane Katrina. U.S. Department of Commerce, National Weather Service, National Hurricane Center, Miami, FL.[]
  29. Lavie CJ, Gerber TC, Lanier WL (2009) Hurricane Katrina: the infarcts beyond the storm. Disaster Med Public Health Prep 3:131–135CrossRefGoogle Scholar
  30. Madamala K, Campbell CR, Hsu EB, Hsieh YH, James J (2009) Characteristics of physician relocation following Hurricane Katrina. Disaster Med Public Health Prep 1:21–26CrossRefGoogle Scholar
  31. Pasch RJ, Brown DP, Blake ES (2005) Tropical Cyclone Report: Hurricane Charley. US Department of Commerce, National Weather Service, National Hurricane Center, Miami, FL. []
  32. Phillips DP, Jarvinen JR, Abramson IS, Phillips RR (2004) Cardiac mortality is higher around Christmas and New Year’s than at any other time. Circulation 110:3781–3788CrossRefGoogle Scholar
  33. Rappaport EN (2000) Loss of life in the United States associated with recent Atlantic tropical cyclones. Bull Am Meteorol Soc 81(9):2065–2073CrossRefGoogle Scholar
  34. Ragan P, Schulte J, Nelson SJ, Jones KT (2008) Mortality surveillance 2004 to 2005: Florida hurricane-related deaths. Am J Forensic Med Pathol 27(2):148–153Google Scholar
  35. Riebsame WE, Diaz HF, Moses T, Price M (1986) The social burden of weather and climate hazards. Bull Am Meteorol Soc 67(11):1378–1388CrossRefGoogle Scholar
  36. Sharma AJ, Weiss EC, Young SL, Stephens K, Ratard R, Straif-Bourgeois S, Sokol TM, Vranken P, Rubin CH (2007) Chronic disease and related conditions at emergency treatment facilities in the New Orleans area after Hurricane Katrina. Disaster Med Public Health Prep 2:27–32CrossRefGoogle Scholar
  37. Shultz JM, Russell J, Espeinel Z (2005) Epidemiology of tropical cyclones: the dynamics of disaster, disease and development. Epidemiol Rev 27:21–35CrossRefGoogle Scholar
  38. Stephens KU, Grew D, Chin K, Kadetz P, Greenough G, Burkle FM, Robinson SL, Franklin ER (2007) Excess mortality in the aftermath of Hurricane Katrina: a preliminary report. Disaster Med Public Health Prep 1(1):21–26CrossRefGoogle Scholar
  39. van den Berg B, Grievink L, Yzermans J, Lebret E (2005) Medically unexplained symptoms in the aftermath of disasters. Epidemiol Rev 27:92–106CrossRefGoogle Scholar
  40. Whitman S, Good G, Donoghue ER, Benbow N, Shou W, Mou S (1997) Mortality in Chicago attributed to the July 1995 heat wave. Am J Public Health 87:1515–1518CrossRefGoogle Scholar
  41. Yzermans CJ, Donker GA, Kerssens JJ, Dirkzwager AJE, Soeteman RJH, ten Veen PMH (2005) Health problems of victims before and after disaster: a longitudinal study in general practice. Int J Epidemiol 34:820–826CrossRefGoogle Scholar
  42. Zachria A, Patel B (2006) Deaths related to Hurricane Rita and mass evacuation. Chest 130:134SGoogle Scholar

Copyright information

© ISB 2010

Authors and Affiliations

  • Nathan McKinney
    • 1
  • Chris Houser
    • 2
    Email author
  • Klaus Meyer-Arendt
    • 1
  1. 1.Department of Environmental StudiesUniversity of West FloridaPensacolaUSA
  2. 2.Department of GeographyTexas A&M UniversityCollege StationUSA

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