{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T20:06:58Z","timestamp":1769630818954,"version":"3.49.0"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u2019s landfall, among Medicare fee-for-service (FFS) beneficiaries aged 65\u202fyears 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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<jats:sub>OVERALL<\/jats:sub> 1.09, 95% CI\u202f=\u202f1.06\u20131.12). 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<jats:sub>NYC<\/jats:sub> 1.08, 95% CI\u202f=\u202f1.02\u20131.15). CT also showed a significant 19% higher risk of long-term mortality up to 5 years (aMRR<jats:sub>CT<\/jats:sub> 1.19, 95% CI\u202f=\u202f1.09\u20131.31). However, the results for NJ and NY were not significant (aMRR<jats:sub>NJ<\/jats:sub>: 1.01, 95% CI\u202f=\u202f0.97\u20131.06; aMRR<jats:sub>NY<\/jats:sub>: 0.96, 95% CI\u202f=\u202f0.86\u20131.07).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1523941","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T05:31:45Z","timestamp":1754458305000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Long-term impacts of hurricanes on mortality among Medicare beneficiaries: evidence from Hurricane Sandy"],"prefix":"10.3389","volume":"13","author":[{"given":"Olivia J.","family":"Keenan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orysya","family":"Soroka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Abramson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monika","family":"Safford","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin F.","family":"Shapiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arnab K.","family":"Ghosh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,6]]},"reference":[{"key":"ref1","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"},{"key":"ref2","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"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1029\/2018EF000825","article-title":"Hurricane Harvey links to ocean heat content and climate change adaptation","volume":"6","author":"Trenberth","year":"2018","journal-title":"Earths Future"},{"key":"ref4","year":"2020"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"756","DOI":"10.3390\/ijerph18052756","article-title":"Perspectives on the health effects of hurricanes: a review and challenges","volume":"18","author":"Waddell","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1016\/S0196-0644(94)70307-8","article-title":"Hurricane-related emergency department visits in an inland area: an analysis of the public health impact of hurricane Hugo in North Carolina","volume":"23","author":"Brewer","year":"1994","journal-title":"Ann Emerg Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1097\/DMP.0b013e31818aaf55","article-title":"Hurricane Katrina deaths, Louisiana, 2005","volume":"2","author":"Brunkard","year":"2008","journal-title":"Disaster Med Public Health Prep"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1017\/dmp.2016.36","article-title":"Injury deaths related to hurricane Sandy, new York City, 2012","volume":"10","author":"Seil","year":"2016","journal-title":"Disaster Med Public Health Prep"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1177\/003335491112600611","article-title":"Adverse respiratory symptoms and environmental exposures among children and adolescents following hurricane Katrina","volume":"126","author":"Rath","year":"2011","journal-title":"Public Health Rep"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1017\/dmp.2016.89","article-title":"Temporal and spatial patterns in utilization of mental health services during and after hurricane Sandy: emergency department and inpatient hospitalizations in new York City","volume":"10","author":"He","year":"2016","journal-title":"Disaster Med Public Health Prep"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1016\/j.emc.2018.07.002","article-title":"Infectious diseases after hydrologic disasters","volume":"36","author":"Liang","year":"2018","journal-title":"Emerg Med Clin North Am"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1017\/S1049023X15004872","article-title":"Impact of a hurricane shelter viral gastroenteritis outbreak on a responding medical team","volume":"30","author":"Gaither","year":"2015","journal-title":"Prehosp Disaster Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"116003","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"},{"key":"ref14","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"},{"key":"ref15","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4020-4598-1_13","article-title":"Flood damage, vulnerability and risk perception \u2013 challenges for flood damage research","volume-title":"Flood risk management: Hazards, vulnerability and mitigation measures","author":"Messner","year":"2006"},{"key":"ref16","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"},{"key":"ref17","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"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1892","DOI":"10.1093\/geronb\/gbac066","article-title":"Long-term impact of hurricane Sandy exposure on positive and negative affect: the role of perceived social support","volume":"77","author":"Wolters","year":"2022","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"112610","DOI":"10.1016\/j.socscimed.2019.112610","article-title":"Twelve years later: the long-term mental health consequences of hurricane Katrina","volume":"242","author":"Raker","year":"2019","journal-title":"Soc Sci Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"153753","DOI":"10.1016\/j.scitotenv.2022.153753","article-title":"Assessing short-term and long-term mental health effects among older adults after hurricane Sandy","volume":"825","author":"Begum","year":"2022","journal-title":"Sci Total Environ"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"114659","DOI":"10.1016\/j.socscimed.2021.114659","article-title":"Long term impact of hurricane Sandy on hospital admissions of older adults","volume":"293","author":"Sands","year":"2022","journal-title":"Soc Sci Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"33","DOI":"10.25646\/11652","article-title":"Health impacts of extreme weather events - cascading risks in a changing climate","volume":"8","author":"Butsch","year":"2023","journal-title":"J Health Monit"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"244","DOI":"10.2105\/AJPH.2018.304846","article-title":"Exploring the environmental justice implications of hurricane Harvey flooding in greater Houston, Texas","volume":"109","author":"Chakraborty","year":"2019","journal-title":"Am J Public Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1007\/s12126-022-09504-7","article-title":"Identifying linkages between climate change, urbanisation, and population ageing for understanding vulnerability and risk to older people: a review","volume":"48","author":"Antal","year":"2023","journal-title":"Ageing Int"},{"key":"ref25","first-page":"19","article-title":"Older people and climate change: vulnerability and health effects","volume":"33","author":"Filiberto","year":"2009","journal-title":"Generations"},{"key":"ref26","first-page":"1","article-title":"Climate, disasters, and extreme weather events: vulnerability, resources, and interventions for lower-income older adults","volume":"45","author":"Merdjanof","year":"2021","journal-title":"Generations"},{"key":"ref27","first-page":"A27","article-title":"Disaster preparedness and the chronic disease needs of vulnerable older adults","volume":"5","author":"Aldrich","year":"2008","journal-title":"Prev Chronic Dis"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1017\/dmp.2017.44","article-title":"Vulnerability of older adults in disasters: emergency department utilization by geriatric patients after hurricane Sandy","volume":"12","author":"Malik","year":"2018","journal-title":"Disaster Med Public Health Prep"},{"key":"ref29","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"},{"key":"ref30","volume-title":"Ten years after Sandy: charting a region's recovery","author":"Abramson","year":"2022"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1007\/s11069-012-0151-3","article-title":"The vulnerability of the elderly to hurricane hazards in Sarasota, Florida","volume":"63","author":"Wang","year":"2012","journal-title":"Nat Hazards"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1175\/WCAS-D-21-0057.1","article-title":"Disasters, displacement, and housing instability: estimating time to stable housing 13 years after hurricane Katrina","volume":"14","author":"Merdjanoff","year":"2022","journal-title":"Weather Climate Soc"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"103608","DOI":"10.1016\/j.regsciurbeco.2020.103608","article-title":"Localized commercial effects from natural disasters: the case of hurricane Sandy and new York City","volume":"86","author":"Meltzer","year":"2021","journal-title":"Reg Sci Urban Econ"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.healthplace.2017.08.007","article-title":"Photovoicing the neighbourhood: understanding the situated meaning of intangible places for ageing-in-place","volume":"48","author":"van Hees","year":"2017","journal-title":"Health Place"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.jrurstud.2015.12.013","article-title":"Coastal climate change, vulnerability and age friendly communities: linking planning for climate change to the age friendly communities agenda","volume":"44","author":"Krawchenko","year":"2016","journal-title":"J Rural Stud"},{"key":"ref36","volume-title":"Aging and urbanization: principles for creating sustainable, growth-oriented and age-friendly cities","year":"2012"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1093\/geronb\/gby126","article-title":"Housing transitions and recovery of older adults following hurricane Sandy","volume":"74","author":"Merdjanoff","year":"2019","journal-title":"J Gerontol"},{"key":"ref38","first-page":"3","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":"ref39","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1353\/sof.0.0047","article-title":"Places as recovery machines: vulnerability and neighborhood change after major hurricanes","volume":"86","author":"Pais","year":"2008","journal-title":"Soc Forces"},{"key":"ref40","year":"2023"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1080\/00431672.2013.762838","article-title":"Hurricane Sandy: the science and impacts of a superstorm","volume":"66","author":"Halverson","year":"2013","journal-title":"Weatherwise"},{"key":"ref42","volume-title":"Costliest U.S. tropical cyclones","year":"2024"},{"key":"ref43","year":"2015"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"2456","DOI":"10.1056\/NEJMp1802313","article-title":"Making neighborhood-disadvantage metrics accessible \u2014 the neighborhood atlas","volume":"378","author":"Kind","year":"2018","journal-title":"N Engl J Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.amjmed.2023.10.012","article-title":"Social vulnerability and cardiovascular-related mortality among older adults in the United States","volume":"137","author":"Minhas","year":"2024","journal-title":"Am J Med"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1404","DOI":"10.2105\/AJPH.2021.306301","article-title":"Income and income inequality are a matter of life and death. What can policymakers Do about it?","volume":"111","author":"Avance\u00f1a","year":"2021","journal-title":"Am J Public Health"},{"key":"ref47","volume-title":"Flooding impacts on household finances: insights from focus groups in New York City","author":"Body","year":"2024"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1007\/s13412-021-00691-4","article-title":"Climate justice and home-buyout programs: renters as a forgotten population in managed retreat actions","volume":"11","author":"Dundon","year":"2021","journal-title":"J Environ Stud Sci"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1146","DOI":"10.1080\/10511482.2022.2055612","article-title":"Who gets emergency housing relief? An analysis of FEMA individual assistance data after hurricane Mar\u00eda","volume":"33","author":"Lamba-Nieves","year":"2023","journal-title":"Hous Policy Debate"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"034043","DOI":"10.1088\/1748-9326\/ac5692","article-title":"Income-based inequality in post-disaster migration is lower in high resilience areas: evidence from U.S. internal migration","volume":"17","author":"Chen","year":"2022","journal-title":"Environ Res Lett"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1146\/annurev-publhealth-012420-105026","article-title":"Extreme weather and climate change: population health and health system implications","volume":"42","author":"Ebi","year":"2021","journal-title":"Annu Rev Public Health"},{"key":"ref52","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"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.2105\/AJPH.2017.303826","article-title":"Hurricane Sandy (New Jersey): mortality rates in the following month and quarter","volume":"107","author":"Kim","year":"2017","journal-title":"Am J Public Health"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"e001354","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"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"e232043","DOI":"10.1001\/jamanetworkopen.2023.2043","article-title":"Mortality after exposure to a hurricane among older adults living with dementia","volume":"6","author":"Bell","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1007\/s11524-018-0280-4","article-title":"Public housing on the periphery: vulnerable residents and depleted resilience reserves post-hurricane Sandy","volume":"95","author":"Hern\u00e1ndez","year":"2018","journal-title":"J Urban Health"},{"key":"ref57","author":"Freed","year":"2024"},{"key":"ref58","author":"Mock","year":"2024"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2013\/913064","article-title":"Health effects of coastal storms and flooding in urban areas: a review and vulnerability assessment","volume":"2013","author":"Lane","year":"2013","journal-title":"J Environ Public Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1523941\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T05:31:48Z","timestamp":1754458308000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1523941\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,6]]},"references-count":59,"alternative-id":["10.3389\/fpubh.2025.1523941"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1523941","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,6]]},"article-number":"1523941"}}