Floods and cause-specific mortality in the United States applying a triply robust approach

Abstract The health impact of floods has not been well characterized. This study evaluated long-term associations between cause-specific mortality rates and county-level monthly flood days (excluding coastal floods caused by tropical storms) in the post-flood year in the contiguous U.S., using a tri...

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Main Authors: Lingzhi Chu, Joshua L. Warren, Erica S. Spatz, Sarah Lowe, Yuan Lu, Xiaomei Ma, Joseph S. Ross, Harlan M. Krumholz, Kai Chen
Format: Article
Language:English
Published: Nature Portfolio 2025-03-01
Series:Nature Communications
Online Access:https://doi.org/10.1038/s41467-025-58236-0
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author Lingzhi Chu
Joshua L. Warren
Erica S. Spatz
Sarah Lowe
Yuan Lu
Xiaomei Ma
Joseph S. Ross
Harlan M. Krumholz
Kai Chen
author_facet Lingzhi Chu
Joshua L. Warren
Erica S. Spatz
Sarah Lowe
Yuan Lu
Xiaomei Ma
Joseph S. Ross
Harlan M. Krumholz
Kai Chen
author_sort Lingzhi Chu
collection DOAJ
description Abstract The health impact of floods has not been well characterized. This study evaluated long-term associations between cause-specific mortality rates and county-level monthly flood days (excluding coastal floods caused by tropical storms) in the post-flood year in the contiguous U.S., using a triply robust approach incorporating propensity score, counterfactual estimation, and confounder adjustment. Death records came from the CDC National Center for Health Statistics (2001-2020) and floods came from the NOAA Storm Events Database (2000-2020). We found that one flood day was associated with 8.3 (95% CI: 2.5 to 14.1) excess all-cause deaths per 10 million individuals, 3.1 due to myocardial infarction, 2.4 due to respiratory diseases, and 5.9 due to external causes. From 2001 to 2020, 22,376 (95% CI: 6,758 to 37,993) all-cause deaths were attributable to floods. Our findings highlight the long-term health risks after floods, and a need for measures to reduce these risks.
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issn 2041-1723
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series Nature Communications
spelling doaj-art-5ff5aeaff5f6496b8ccd95d43818eeaf2025-08-20T02:10:13ZengNature PortfolioNature Communications2041-17232025-03-011611910.1038/s41467-025-58236-0Floods and cause-specific mortality in the United States applying a triply robust approachLingzhi Chu0Joshua L. Warren1Erica S. Spatz2Sarah Lowe3Yuan Lu4Xiaomei Ma5Joseph S. Ross6Harlan M. Krumholz7Kai Chen8Department of Environmental Health Sciences, Yale School of Public HealthDepartment of Biostatistics, Yale School of Public HealthCenter for Outcomes Research and Evaluation, Yale-New Haven HospitalDepartment of Social and Behavioral Sciences, Yale School of Public HealthCenter for Outcomes Research and Evaluation, Yale-New Haven HospitalDepartment of Chronic Disease Epidemiology, Yale School of Public HealthCenter for Outcomes Research and Evaluation, Yale-New Haven HospitalCenter for Outcomes Research and Evaluation, Yale-New Haven HospitalDepartment of Environmental Health Sciences, Yale School of Public HealthAbstract The health impact of floods has not been well characterized. This study evaluated long-term associations between cause-specific mortality rates and county-level monthly flood days (excluding coastal floods caused by tropical storms) in the post-flood year in the contiguous U.S., using a triply robust approach incorporating propensity score, counterfactual estimation, and confounder adjustment. Death records came from the CDC National Center for Health Statistics (2001-2020) and floods came from the NOAA Storm Events Database (2000-2020). We found that one flood day was associated with 8.3 (95% CI: 2.5 to 14.1) excess all-cause deaths per 10 million individuals, 3.1 due to myocardial infarction, 2.4 due to respiratory diseases, and 5.9 due to external causes. From 2001 to 2020, 22,376 (95% CI: 6,758 to 37,993) all-cause deaths were attributable to floods. Our findings highlight the long-term health risks after floods, and a need for measures to reduce these risks.https://doi.org/10.1038/s41467-025-58236-0
spellingShingle Lingzhi Chu
Joshua L. Warren
Erica S. Spatz
Sarah Lowe
Yuan Lu
Xiaomei Ma
Joseph S. Ross
Harlan M. Krumholz
Kai Chen
Floods and cause-specific mortality in the United States applying a triply robust approach
Nature Communications
title Floods and cause-specific mortality in the United States applying a triply robust approach
title_full Floods and cause-specific mortality in the United States applying a triply robust approach
title_fullStr Floods and cause-specific mortality in the United States applying a triply robust approach
title_full_unstemmed Floods and cause-specific mortality in the United States applying a triply robust approach
title_short Floods and cause-specific mortality in the United States applying a triply robust approach
title_sort floods and cause specific mortality in the united states applying a triply robust approach
url https://doi.org/10.1038/s41467-025-58236-0
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