Hurricane Death Toll in Puerto Rico Higher Than Official Count, Another Study Finds

Another study examining the death toll in Puerto Rico after Hurricane Maria last year came up with another number that is higher than the official death toll of 64. Using records of vital statistics, the researchers said there were at least 1139 excess deaths.

Another study examining the death toll in Puerto Rico after Hurricane Maria last year came up with another number that is higher than the official death toll of 64.

There have been various estimates of the number of deaths in Puerto Rico from Hurricane Maria, which hit the island almost a year ago, in September 2017, causing about $90 billion worth of damage. The island is still not completely recovered, with some residents in the territory without roofs or electricity.

In May, a study in the New England Journal of Medicine estimated the deaths from the storm at more than 4600. In June, the government in Puerto Rico said that the number of deaths from September to December 2017 surpassed the average for the same period over the previous 4 years by more than 1400.

But a research letter in JAMA, using records of vital statistics, estimated the number of deaths at 1139, and the authors said the number is conservative. This is the first study to use vital statistic records to try and give an accurate toll of the number of deaths. The researchers said using vital statistic records provides for a more accurate accounting.

The study said the difference in numbers has to do the different methodologies that researchers are using to discover what happened, and pointed out that accurate estimates are important for “informing rescue, recovery, and policy decisions.”

The official government death toll includes some deaths in which documentation of “hurricane-related” as the cause of death appears on the individual’s death certificate and does not account for indirect deaths, including from infectious disease outbreaks or lack of services such as electricity, water, and healthcare.

Those estimates of indirect deaths, which produce higher results, usually use death counts from either government agencies or surveys and are susceptible to larger margins of error, the study said.

To conduct the analysis, researchers used monthly death counts, from January 2010 through December 2017, including previously unavailable death counts for January through December 2017.

Compared with what would historically be expected, the researchers said there were 1139 (95% CI, 1006-1272) excess deaths: 459 (95% CI, 425-593) in September, 564 (95% CI, 531-597) in October, and 116 (95% CI, 50-182) in November.

“The estimate is conservative, because the expected number of deaths used the upper 95% CI and did not consider the population denominators, which were decreasing,” the researchers wrote.

Chronic diseases like asthma and diabetes are widespread in the poverty-stricken US territory, and NPR reported this week that severe Medicaid cuts will further hurt efforts to care for residents.

Because Puerto Rico is not a state, the federal government only pays 19% of its Medicaid costs, instead of 83% if it were a state. Puerto Rico’s debt is more than $70 billion, and because of its agreement with the United States, it must cut $840.2 million from Medicaid by 2023.

The local government is having insurers lock patients into narrow networks, and later this year, health insurers will have to compete for customers island-wide, the NPR report said.

In 2016, Medicaid expenses totaled $2.4 billion; the program covers nearly 50% of residents in Puerto Rico.

Compounding the myriad problems, many healthcare professionals have left the island for the mainland.


Santos-Lozada AR, Howard JT. Use of death counts from vital statistics to calculate excess deaths in Puerto Rico following Hurricane Maria [published online August 2, 2018]. JAMA. doi: 10.1001/jama.2018.10929.

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