Flooding from Hurricane Sandy raises heart disease risk years later

Although the material damage from 2012's Hurricane Sandy may have been repaired, the storm left a lasting impact on cardiovascular health, according to new findings from Weill Cornell Medicine and New York University researchers.

The study, published Sept. 3 in JAMA Network Open, found that older adults living in flood-hit areas in New Jersey faced a 5% higher risk of heart disease for up to five years after Sandy's landfall. This is one of the first studies to rigorously quantify long-term cardiovascular risks associated with flooding in older adults. Most studies focus on the immediate consequences of severe weather events.

"Climate-amplified hurricanes and hurricane-related floods are expected to increase into the future," said Dr. Arnab Ghosh, assistant professor of medicine at Weill Cornell Medicine and an internist at NewYork-Presbyterian/Weill Cornell Medical Center, who led the research. "So, it's essential to understand the long-term health effects on those most vulnerable."

Natural controlled experiment

The researchers analyzed Medicare data from over 120,000 people aged 65 and older living in New Jersey, New York City, and Connecticut in the five years after the storm.

They compared ZIP code areas that were flooded during the hurricane to nearby ZIP code areas that weren't, matching the communities in terms of age, income, race and health status before the storm. Using advanced statistical models, the team tracked heart-related health events like heart attacks, strokes and heart failure in people who did not relocate after the hurricane.

Capitalizing on such a large, diverse and stable patient population as Medicare recipients, allowed our team to see broader population trends while controlling for many of the threats to validity, whether socio-economic factors or the prevalence of co-morbidities."

Dr. David Abramson, senior author, clinical professor of social and behavioral sciences in the School of Global Public Health, New York University

The researchers concluded that heart failure rates were higher in flooded areas, especially in New Jersey, and that the risk persisted for four to five years-not just weeks or months-after the storm.

They hypothesize that more people in New Jersey were directly affected by the storm's physical and emotional stressors. Flooded zip codes in New Jersey had lower median incomes and higher area deprivation index scores, which are indicators of social and economic disadvantage. These factors are linked to worse health outcomes and lower access to care, especially after a disaster. The residents also faced lingering difficult environmental and psychological circumstances and reduced community support.

In a related study published last month in Frontiers in Public Health, Dr. Ghosh and his colleagues found that the rate of death in elderly individuals living in areas flooded after Sandy was 9% higher on average five years later compared to those in less affected neighborhoods. The magnitude of this effect varied by region. While New York City saw an 8% increase in mortality, Connecticut had a 19% increase. However, the rest of coastal New York, including Long Island, and New Jersey seemed to escape this effect.

"The regional differences that we noted may highlight how local environments differ and need further examination," Dr. Ghosh said. "New York City, for example, is heavily urbanized, while impacted parts of Connecticut and New Jersey are suburban with different infrastructure and more single-family homes."

Taking a longer-term view

The study suggests that disaster preparedness and recovery frameworks should integrate chronic disease management and long-term health monitoring, not just short-term emergency care. The findings are particularly relevant for climate resilience planning, especially in regions with aging populations and increasing hurricane exposure.

"We are starting to appreciate that disasters are happening more frequently. But our policies and support systems for vulnerable groups after severe weather has struck haven't been well developed," Dr. Ghosh said.

Given the regional variation in health outcomes, localized health system preparedness is essential, added the researchers. This includes resource allocation, training and infrastructure to manage chronic disease burdens in the aftermath of disasters.

"With this work, we lay the groundwork to show that hurricanes can have long-term impacts on health," said Dr. Ghosh. Building on these results, the researchers are now planning to conduct larger-scale analyses on the health consequences of other events such as wildfires and tornadoes. Another aspect they plan to study involves how increased health risks related to weather affect Medicare, Medicaid and the health care system financially.