{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T01:12:55Z","timestamp":1791853975749,"version":"4.3.4"},"reference-count":50,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Hurricanes are associated with increased cardiovascular disease (CVD) risk, yet little is known about whether these risks extend into the long term and for how long.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine the association between hurricane-related flooding and CVD risk up to 5 years after landfall.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study included a 20% national sample of continuously enrolled Medicare fee-for-service beneficiaries from New Jersey, New York City, and Connecticut from January 1, 2010, to December 31, 2017. Data were analyzed from December 14, 2023, to June 20, 2025.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Residence in zip code tabulation areas (ZCTAs) impacted by flooding from Hurricane Sandy throughout the study period.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was the rate of ZCTA-level adjusted CVD events (including myocardial infarction [MI], heart failure [HF], and stroke), defined per 1000 beneficiary-years, with associated 95% bayesian credible intervals (bCrIs). Secondary outcomes included the rate of events for each CVD subtype (MI, HF, and stroke).<\/jats:p><\/jats:sec>Results<\/jats:title>In the matched cohort, 121\u202f395 beneficiaries resided in 690 ZCTAs, of which 441 (63.9%) flooded. In nonflooded vs flooded ZCTAs, mean (SD) age (74.2 [1.4] vs 74.1 [1.2] years; P<\/jats:italic>\u2009=\u2009.16), proportion of female beneficiaries (61.4% [8.4%] vs 61.3% [6.6%]; P<\/jats:italic>\u2009=\u2009.89), and proportion of White beneficiaries (74.3% [28.7%] vs 76.7% [26.8%]; P<\/jats:italic>\u2009=\u2009.27) were similar, but ZCTA-level median income ($81\u202f168 [$33 410] vs $69\u202f650 [$27 594]; P<\/jats:italic>\u2009&amp;lt;\u2009.001) and median National Area Deprivation Index rank (17.1 [IQR, 10.2-27.6] vs 21.0 [IQR, 10.9-32.5]; P<\/jats:italic>\u2009=\u2009.02) differed; prevalence of CVD and CVD subtypes was similar at baseline. Flooding was associated with an increase in adjusted 5-year CVD risk post landfall (relative risk, 1.05; 95% bCrI, 1.01-1.08) and HF rates overall (relative risk, 1.03; 95% bCrI, 1.00-1.08). No significant difference was found in rates of MI or stroke in adjusted analyses.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of Medicare fee-for-service beneficiaries, hurricane-related flooding was associated with increases in CVD event rates as long as 5 years after landfall and increased HF rates in New Jersey. These findings highlight the importance of place-based vulnerability from hurricane exposure to mitigate longer-term CVD risk and the need to consider long-term outcomes in hurricane mitigation efforts.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.30335","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T15:00:29Z","timestamp":1756911629000},"page":"e2530335","source":"Crossref","is-referenced-by-count":2,"title":["Hurricane Exposure and Risk of Long-Term Cardiovascular Disease Outcomes"],"prefix":"10.1001","volume":"8","author":[{"given":"Arnab K.","family":"Ghosh","sequence":"first","affiliation":[{"name":"Department of Medicine, Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orysya","family":"Soroka","sequence":"additional","affiliation":[{"name":"Department of Medicine, Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Safford","sequence":"additional","affiliation":[{"name":"Department of Medicine, Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin F.","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Department of Medicine, Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glen D.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Environmental, Occupational and Geospatial Health Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasin","family":"Civelek","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Weill Cornell Medicine, New York, New York"},{"name":"Cornell Health Policy Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"DiMaggio","sequence":"additional","affiliation":[{"name":"Department of Surgery, New York University School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Abramson","sequence":"additional","affiliation":[{"name":"School of Global Public Health, New York University, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"issue":"18","key":"zoi250853r1","doi-asserted-by":"publisher","first-page":"7203","DOI":"10.1175\/JCLI-D-15-0129.1","article-title":"Global projections of intense tropical cyclone activity for the late twenty-first century from dynamical downscaling of CMIP5\/RCP4.5 scenarios.","volume":"28","author":"Knutson","year":"2015","journal-title":"J Clim"},{"issue":"22","key":"zoi250853r2","doi-asserted-by":"publisher","first-page":"11975","DOI":"10.1073\/pnas.1920849117","article-title":"Global increase in major tropical cyclone exceedance probability over the past four decades.","volume":"117","author":"Kossin","year":"2020","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"20","key":"zoi250853r3","doi-asserted-by":"publisher","first-page":"8281","DOI":"10.1175\/JCLI-D-17-0898.1","article-title":"Projected response of tropical cyclone intensity and intensification in a global climate model.","volume":"31","author":"Bhatia","year":"2018","journal-title":"J Clim"},{"issue":"11","key":"zoi250853r4","doi-asserted-by":"publisher","DOI":"10.1289\/EHP11252","article-title":"Impact of hurricanes and associated extreme weather events on cardiovascular health: a scoping review.","volume":"130","author":"Ghosh","year":"2022","journal-title":"Environ Health Perspect"},{"issue":"1","key":"zoi250853r5","doi-asserted-by":"publisher","first-page":"74","DOI":"10.3390\/ijerph16010074","article-title":"Cardiovascular disease hospitalizations in Louisiana parishes\u2019 elderly before, during and after Hurricane Katrina.","volume":"16","author":"Becquart","year":"2018","journal-title":"Int J Environ Res Public Health"},{"issue":"11","key":"zoi250853r6","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.15111","article-title":"Association between a temporary reduction in access to health care and long-term changes in hypertension control among veterans after a natural disaster.","volume":"2","author":"Baum","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"9","key":"zoi250853r7","doi-asserted-by":"publisher","first-page":"1632","DOI":"10.2337\/dc09-0670","article-title":"Impact of a natural disaster on diabetes: exacerbation of disparities and long-term consequences.","volume":"32","author":"Fonseca","year":"2009","journal-title":"Diabetes Care"},{"issue":"1","key":"zoi250853r8","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2016-000248","article-title":"Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy.","volume":"4","author":"Lee","year":"2016","journal-title":"BMJ Open Diabetes Res Care"},{"issue":"11","key":"zoi250853r9","doi-asserted-by":"publisher","first-page":"2090","DOI":"10.2337\/dc19-0567","article-title":"Long-term effects of disasters on seniors with diabetes: evidence from Hurricanes Katrina and Rita.","volume":"42","author":"Quast","year":"2019","journal-title":"Diabetes Care"},{"issue":"10","key":"zoi250853r10","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1001\/jama.2022.1682","article-title":"Association of tropical cyclones with county-level mortality in the US.","volume":"327","author":"Parks","year":"2022","journal-title":"JAMA"},{"issue":"1","key":"zoi250853r11","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1038\/s41467-021-21777-1","article-title":"Tropical cyclone exposure is associated with increased hospitalization rates in older adults.","volume":"12","author":"Parks","year":"2021","journal-title":"Nat Commun"},{"issue":"2","key":"zoi250853r12","doi-asserted-by":"publisher","first-page":"482","DOI":"10.3390\/ijerph17020482","article-title":"Short-term solutions to a long-term challenge: rethinking disaster recovery planning to reduce vulnerabilities and inequities.","volume":"17","author":"Finucane","year":"2020","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"zoi250853r13","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1017\/dmp.2018.152","article-title":"After the storm: short-term and long-term health effects following Superstorm Sandy among the elderly.","volume":"13","author":"Lawrence","year":"2019","journal-title":"Disaster Med Public Health Prep"},{"issue":"1","key":"zoi250853r14","doi-asserted-by":"publisher","first-page":"3","DOI":"10.7249\/RR2313","article-title":"Improving disaster resilience among older adults: insights from public health departments and aging-in-place efforts.","volume":"8","author":"Shih","year":"2018","journal-title":"Rand Health Q"},{"key":"zoi250853r15","doi-asserted-by":"publisher","DOI":"10.1016\/j.envsci.2024.103866","article-title":"When does place attachment lead to climate change adaptation and when does it not? a quantitative review and thematic analysis.","volume":"160","author":"Jayakody","year":"2024","journal-title":"Environ Sci Policy"},{"issue":"4","key":"zoi250853r16","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1093\/geront\/15.4.357","article-title":"The elderly in the aftermath of a disaster.","volume":"15","author":"Poulshock","year":"1975","journal-title":"Gerontologist"},{"issue":"3","key":"zoi250853r17","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1017\/dmp.2016.75","article-title":"Effect of Hurricane Sandy on health care services utilization under Medicaid.","volume":"10","author":"Sharp","year":"2016","journal-title":"Disaster Med Public Health Prep"},{"issue":"4","key":"zoi250853r18","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1177\/0033354920930133","article-title":"Disparities in health effects and access to health care among Houston area residents after Hurricane Harvey.","volume":"135","author":"Flores","year":"2020","journal-title":"Public Health Rep"},{"key":"zoi250853r19","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2020.109384","article-title":"A spatial analysis of climate gentrification in Orleans Parish, Louisiana post-Hurricane Katrina.","volume":"185","author":"Aune","year":"2020","journal-title":"Environ Res"},{"key":"zoi250853r20","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2019.102237","article-title":"Effects of gentrification on health status after Hurricane Katrina.","volume":"61","author":"Schnake-Mahl","year":"2020","journal-title":"Health Place"},{"issue":"1","key":"zoi250853r21","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1177\/0002716216682942","article-title":"Weather-related hazards and population change: a study of hurricanes and tropical storms in the United States, 1980-2012.","volume":"669","author":"Fussell","year":"2017","journal-title":"Ann Am Acad Pol Soc Sci"},{"issue":"6","key":"zoi250853r23","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2021.0290","article-title":"\u201cNatural experiments\u201d in health care research.","volume":"2","author":"Khullar","year":"2021","journal-title":"JAMA Health Forum"},{"issue":"3","key":"zoi250853r24","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1007\/s10745-015-9757-x","article-title":"Superstorm Sandy and the demographics of flood risk in New York City.","volume":"43","author":"Faber","year":"2015","journal-title":"Hum Ecol"},{"issue":"5","key":"zoi250853r25","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1038\/s41370-020-0230-6","article-title":"Unequal social vulnerability to Hurricane Sandy flood exposure.","volume":"31","author":"Lieberman-Cribbin","year":"2021","journal-title":"J Expo Sci Environ Epidemiol"},{"issue":"6","key":"zoi250853r26","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1080\/02601370.2015.1116116","article-title":"Community response in disasters: an ecological learning framework.","volume":"34","author":"Preston","year":"2015","journal-title":"Int J Lifelong Educ"},{"issue":"4","key":"zoi250853r27","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1038\/s41591-024-02833-x","article-title":"Impact of extreme weather events on healthcare utilization and mortality in the United States.","volume":"30","author":"Salas","year":"2024","journal-title":"Nat Med"},{"issue":"9","key":"zoi250853r29","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1093\/aje\/kwv116","article-title":"Optimal use of available claims to identify a Medicare population free of coronary heart disease.","volume":"182","author":"Kent","year":"2015","journal-title":"Am J Epidemiol"},{"issue":"12","key":"zoi250853r30","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1097\/MLR.0000000000001004","article-title":"Use of Medicare claims data for the identification of myocardial infarction: the Reasons for Geographic and Racial Differences in Stroke Study.","volume":"56","author":"Colantonio","year":"2018","journal-title":"Med Care"},{"issue":"S1","key":"zoi250853r31","doi-asserted-by":"publisher","first-page":"S46","DOI":"10.1001\/dmp.2010.14","article-title":"Measuring individual disaster recovery: a socioecological framework.","volume":"4","author":"Abramson","year":"2010","journal-title":"Disaster Med Public Health Prep"},{"issue":"4","key":"zoi250853r32","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1111\/0004-5608.00219","article-title":"Revealing the vulnerability of people and places: a case study of Georgetown County, South Carolina.","volume":"90","author":"Cutter","year":"2000","journal-title":"Ann Assoc Am Geogr"},{"issue":"1","key":"zoi250853r33","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1023\/B:NHAZ.0000026792.76181.d9","article-title":"Poverty and disasters in the United States: a review of recent sociological findings.","volume":"32","author":"Fothergill","year":"2004","journal-title":"Nat Hazards"},{"issue":"8","key":"zoi250853r34","doi-asserted-by":"publisher","first-page":"775","DOI":"10.3390\/ijerph13080775","article-title":"Exposure to flood hazards in Miami and Houston: are Hispanic immigrants at greater risk than other social groups?","volume":"13","author":"Maldonado","year":"2016","journal-title":"Int J Environ Res Public Health"},{"key":"zoi250853r35","doi-asserted-by":"publisher","first-page":"255","DOI":"10.3354\/cr022255","article-title":"Vulnerability of coastal communities to sea-level rise: a case study of Cape May County, New Jersey, USA.","volume":"22","author":"Wu","year":"2002","journal-title":"Clim Res"},{"issue":"4","key":"zoi250853r36","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.1111\/ssqu.12114","article-title":"Homeownership and housing displacement after Hurricane Katrina among low-income African-American mothers in New Orleans.","volume":"95","author":"Fussell","year":"2014","journal-title":"Soc Sci Q"},{"issue":"4","key":"zoi250853r37","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1111\/j.1467-7717.2008.01054.x","article-title":"Social vulnerability and the natural and built environment: a model of flood casualties in Texas.","volume":"32","author":"Zahran","year":"2008","journal-title":"Disasters"},{"issue":"26","key":"zoi250853r38","doi-asserted-by":"publisher","first-page":"2456","DOI":"10.1056\/NEJMp1802313","article-title":"Making neighborhood disadvantage metrics accessible: the Neighborhood Atlas.","volume":"378","author":"Kind","year":"2018","journal-title":"N Engl J Med"},{"key":"zoi250853r39","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/BF00116466","article-title":"Bayesian image restoration, with two applications in spatial statistics.","volume":"43","author":"Besag","year":"1991","journal-title":"Ann Inst Stat Math"},{"issue":"25","key":"zoi250853r40","doi-asserted-by":"publisher","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.","volume":"28","author":"Austin","year":"2009","journal-title":"Stat Med"},{"issue":"6","key":"zoi250853r41","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001354","article-title":"The effect of Hurricane Sandy on cardiovascular events in New Jersey.","volume":"3","author":"Swerdel","year":"2014","journal-title":"J Am Heart Assoc"},{"issue":"8037","key":"zoi250853r42","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1038\/s41586-024-07945-5","article-title":"Mortality caused by tropical cyclones in the United States.","volume":"635","author":"Young","year":"2024","journal-title":"Nature"},{"issue":"1","key":"zoi250853r43","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s12889-022-14919-7","article-title":"Differences in county-level cardiovascular disease mortality rates due to damage caused by Hurricane Matthew and the moderating effect of social capital: a natural experiment.","volume":"23","author":"McCann","year":"2023","journal-title":"BMC Public Health"},{"issue":"5","key":"zoi250853r44","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1097\/EDE.0000000000001755","article-title":"Advances in difference-in-differences methods for policy evaluation research.","volume":"35","author":"Wang","year":"2024","journal-title":"Epidemiology"},{"issue":"11","key":"zoi250853r45","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.117.004402","article-title":"Contemporary epidemiology of heart failure in fee-for-service Medicare beneficiaries across healthcare settings.","volume":"10","author":"Khera","year":"2017","journal-title":"Circ Heart Fail"},{"issue":"1","key":"zoi250853r47","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1097\/EDE.0000000000001676","article-title":"Universal difference-in-differences for causal inference in epidemiology.","volume":"35","author":"Tchetgen Tchetgen","year":"2024","journal-title":"Epidemiology"},{"issue":"1","key":"zoi250853r48","doi-asserted-by":"publisher","first-page":"1982","DOI":"10.1186\/s12889-023-16877-0","article-title":"Does disaster-related relocation impact mental health via changes in group participation among older adults? causal mediation analysis of a pre-post disaster study of the 2016 Kumamoto earthquake.","volume":"23","author":"Matsuoka","year":"2023","journal-title":"BMC Public Health"},{"issue":"3","key":"zoi250853r49","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1007\/s10584-021-03069-1","article-title":"When rebuilding no longer means recovery: the stress of staying put after Hurricane Sandy.","volume":"165","author":"Koslov","year":"2021","journal-title":"Clim Change"},{"issue":"5","key":"zoi250853r50","doi-asserted-by":"publisher","first-page":"819","DOI":"10.2105\/AJPH.84.5.819","article-title":"The fallacy of the ecological fallacy: the potential misuse of a concept and the consequences.","volume":"84","author":"Schwartz","year":"1994","journal-title":"Am J Public Health"},{"key":"zoi250853r22","volume-title":"National Disaster Recovery Framework","year":"2016"},{"key":"zoi250853r28","unstructured":"Centers for Medicare and Medicaid Services. Chronic Conditions Data Warehouse. 2025. Accessed January 24, 2024. https:\/\/www2.ccwdata.org\/web\/guest\/data-dictionaries"},{"key":"zoi250853r46","unstructured":"National Oceanic and Atmospheric Administration. Costliest U.S. tropical cyclones. 2024. Accessed August 24, 2024. https:\/\/www.ncei.noaa.gov\/access\/billions\/dcmi.pdf"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2838441\/ghosh_2025_oi_250853_1756232932.02653.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T15:00:32Z","timestamp":1756911632000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2838441"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,3]]},"references-count":50,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.30335","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,3]]}}}