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Health Care Access and Health Indicators in Puerto Rico Pre- and Post- Hurricane Maria: Behavioral Risk Factor Surveillance System (2015–2019)

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Abstract

Hurricane Maria is regarded as one of the worst natural disasters in United States history as it devasted Puerto Rico (PR) in September 2017. This study compared population-based key health indicators among PR residents pre-and post-Hurricane Maria. We examined Behavioral Risk Factor Surveillance System (BRFSS) PR data from five survey years, including pre-and post-Hurricane Maria: 2015 (N = 4556), 2016 (N = 5765), 2017 (N = 4462), 2018 (N = 4814), and 2019 (N = 4958). The sample consisted of non-institutionalized adults aged ≥ 18 years with access to a landline or a cellular telephone. Using logistic regression we compared health care utilization, health behaviors, and outcomes pre-and post-Hurricane Maria. Models adjusted for age, sex, race, education, employment, income, and marital status (2017 = referent). Compared to 2017, post-hurricane participants were more likely to have a college degree or higher, be currently employed, and not married/partnered. Post-hurricane, participants were less likely to have health insurance coverage (2018 AOR, 95% CI: 0.75, 0.58–0.97) and had lower rates of diabetes (2018 AOR: 0.82, 0.70–0.96). The odds of being overweight/obese were lower pre-hurricane compared to 2017 (2015 AOR, 95% CI: 0.88, 0.79–0.97). There was no statistically significant difference in health behaviors across survey years. Results may suggest that PR residents with lower socioeconomic status and/or chronic illness were more likely to emigrate, resulting in a compositional change in the population post-hurricane. This analysis highlights the need for long-term follow-up of PR residents to better determine the impact of Hurricane Maria, and adequately design public health programs to address healthcare needs, access, and outcomes.

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References

  1. RAND Corporation. Hurricanes Irma and Maria: Impact and Aftermath. Homeland Security Operational Analyst. 2020. https://www.rand.org/hsrd/hsoac/projects/puerto-rico-recovery/hurricanes-irma-and-maria.html. Accessed April 5, 2022.

  2. Perreira K, et al, Puerto Rico Health Care Infrastructure Assessment. Urban Institute. 2017. https://www.urban.org/sites/default/files/publication/87011/2001050-puerto-rico-health-care-infratructure-assessment-site-visit-report_1.pdf. Accessed October 20, 2021.

  3. Perreira K, et al., Environmental Scan of Puerto Rico’s Health Care Infrastructure. Urban Institute, 2017. https://www.urban.org/sites/default/files/publication/87016/200105-environmental-scan-of-puerto-ricos-health-care-infrastructure_1.pdf. Accessed October 20, 2021.

  4. Fischbach JR, et al. After Hurricane Maria: Predisaster Conditions, Hurricane Damage, and Recovery Needs in Puerto Rico. Homeland Security Operational Analysis Center operated by the RAND Corporation, 2020. https://www.rand.org/pubs/research_reports/RR2595.html. Accessed October 20, 2021.

  5. Kishore N, et al. Mortality in Puerto Rico after Hurricane Maria. N Engl J Med. 2018;379(2):162–70.

    Article  PubMed  Google Scholar 

  6. Santos-Burgoa C, et al. Differential and persistent risk of excess mortality from Hurricane Maria in Puerto Rico: a time-series analysis. Lancet Planet Health. 2018;2(11):e478–88.

    Article  PubMed  Google Scholar 

  7. Caban P. Hurricane Maria’s Aftermath: Redefining Puerto Rico’s Colonial Status. Caribbean Latino Studies Faculty Scholarship: Latin American; 2019. p. 34 https://scholarsarchive.library.albany.edu/lacs_fac_scholar/34.

    Google Scholar 

  8. Rivera Joseph S. et a. Colonial neglect and the right to health in Puerto Rico after Hurricane Maria. Am J Public Health. 2020;110(10):1512–8.

    Article  Google Scholar 

  9. Giorgadze T, et al. Disasters and their consequences for public health. Georgian Med News, 2011(194): 59–63.

  10. Ridenour ML, et al. Displacement of the underserved: Medical needs of Hurricane Katrina evacuees in West Virginia. J Health Care Poor Underserved. 2007;18(2):369–81.

    Article  PubMed  Google Scholar 

  11. Davis JR, et al. The impact of disasters on populations with health and health care disparities. Disaster Med Public Health Prep. 2010;4(1):30–8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hinojosa J, et al Puerto Rican Post-Maria Relocation by States. 2018, Center for Puerto Rican Studies Hunter College, CUNY. https://centropr.hunter.cuny.edu/research/data-center/research-briefs/puerto-rican-post-maria-relocation-states. Accessed November 5, 2021.

  13. Schachter J, Bruce A, Revising methods to better reflect the impact of the disaster. United States Census Bureau, 2020. https://www.census.gov/library/stories/2020/08/estimating-puerto-rico-population-after-hurricane-maria.html. Accessed April 5, 2022.

  14. Centers for Disease Control and Prevention. The Behavioral Risk Factor Surveillance System (BRFSS). National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. 2021. https://www.cdc.gov/brfss/index.html. Accessed November 5, 2021.

  15. Centers for Disease Control and Prevention. BRFSS Prevalence & Trends Data. National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, 2017. https://www.cdc.gov/brfss/brfssprevalence/index.html. Accessed November 5, 2021.

  16. Centers for Disease Control and Prevention. BRFSS 2017 Summary Data Quality Report, Division of Population Health. 2018. https://www.cdc.gov/brfss/annual_data/2017/pdf/2017-sdqr-508.pdf. Accessed November 5, 2021.

  17. United States Census Bureau. About the Puerto Rico. 2022. https://www.census.gov/programs-surveys/acs/about/puerto-rico-community-survey.html. Accessed June 17, 2022.

  18. Keith-Jennings B, Wolkomir E. How does household food assistance in Puerto Rico compared to the rest of the United States. Center for Budget and Policy Priorities, 2020. https://www.cbpp.org/research/food-assistance/how-does-household-food-assistance-in-puerto-rico-compare-to-the-rest-of. Accessed April 5, 2022.

  19. Mellgard G, et al. Hurricanes, and healthcare: a case report on the influences of Hurricane Maria and managed Medicare in treating a Puerto Rican resident. BMC Health Serv Res. 2019;19:818. https://doi.org/10.1186/s12913-019-4630-z.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mora MT, et al Migration, Geographic Destinations, and Socioeconomic Outcomes of Puerto Ricans during La Crisis Boricua: Implications for Island and Stateside Communities Post-Maria. CENTRO: Journal of the Center for Puerto Rican Studies, Fall 2018. 30(3): 208–229.

  21. Glassman, B A Third of Movers From Puerto Rico to the Mainland United States Relocated to Florida in 2018, 2019. https://www.census.gov/library/stories/2019/09/puerto-rico-outmigration-increases-poverty-declines.html. Accessed October 15, 2021.

  22. Caraballo-Cueto J. The Exacerbating effects of hurricanes on Puerto Rico’s (broken) economy. Hispanic Economic Outlook, 2018. Available on Research Gate, https://www.researchgate.net/publication/328102486_Special_Edition_Puerto_Rico_Before_and_After_Hurricane_Maria. Accessed October 15, 2021.

  23. Valle AJ. I am not your immigrant: Puerto Ricans, liminal citizenship, and politics in Florida, 2019. Doctoral dissertation, University of Los Angeles. ProQuest ID: Valle_ucla_0031D_17775. Merritt ID: ark:/13030/m5c58jwt. Retrieved from https://escholarship.org/uc/item/5r76x28w. Accessed June 17, 2022.

  24. Pierannunzi C, et al. A systematic review of publications assessing reliability and validity of the Behavioral Risk Factor Surveillance System (BRFSS), 2004–2011. BMC Med Res Methodol, 2013. 13;49. https://doi.org/10.1186/1471-2288-13-49. Accessed October 15, 2021.

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Funding

Support was provided by the NC TraCS Inclusive Science Program (ISP) UL1TR002489 (Perreira).

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Authors and Affiliations

  1. School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall Campus #7460, 27599-7460, Chapel Hill, NC, USA

    Yamnia I. Cortés

  2. Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, 209 Fetzer Hall CB#8700, 210 South Road, 27599-8700, Chapel Hill, NC, USA

    Patricia Pagan Lassalle

  3. Department of Social Medicine, University of North Carolina at Chapel Hill, MacNider Hall Campua Box #7240, 27599-7240, Chapel Hill, NC, USA

    Krista M. Perreira

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  1. Yamnia I. Cortés
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  2. Patricia Pagan Lassalle
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  3. Krista M. Perreira
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Contributions

Drs. Cortes and Perreira collaborated in the conceptualization of the analysis and Ms. Pagan Lassalle completed the data analysis. All authors collaborated in the interpretation of findings and manuscript preparation. All authors reviewed and approved the final manuscript.

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Correspondence to Yamnia I. Cortés.

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Cortés, Y.I., Lassalle, P.P. & Perreira, K.M. Health Care Access and Health Indicators in Puerto Rico Pre- and Post- Hurricane Maria: Behavioral Risk Factor Surveillance System (2015–2019). J Immigrant Minority Health 25, 247–254 (2023). https://doi.org/10.1007/s10903-022-01391-z

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