Counting Every Death When Every Death Counts: A Mixed-Methods Study of Hurricane Michael Excess Mortality

Vulnerable populations have been shown to be disproportionately impacted by natural disasters, such as hurricanes. Hurricane Michael, a Category 5 storm, in October of 2018 hit the rural and socioeconomically vulnerable area of the Florida Panhandle, causing 50 fatalities in Florida, massive destruction to area including the healthcare infrastructure, and led a prolonged recovery period. The purpose of the research was to examine long-term impacts to health in Florida Panhandle after Hurricane Michael; changes to mortality trends, changes to health of survivors, and changes to their access to health care using a mixed-methods, sequential, explanatory study design. The initial phase was excess mortality modeling that used vital statistics death records and a seasonally adjusted ARIMA analyze changes in mortality rates for the year post-storm in two coastal areas, Bay County, and combined Gulf and Franklin Counties. Results were that in Quarter 2 of 2019 (April-June), crude mortality was forecasted for Gulf and Franklin Counties to be 227.8 (95% CI 159.8, 316.0) (per 100,00), though the observed mortality rate was 322.5, showing evidence of excess mortality though no such evidence was found for Bay County. Also in Gulf and Franklin Counties, for Quarter 2 2019, evidence of excess mortality was found for those 55 and older and Whites, and in Quarter 3 of 2019 (July-September) cancer-related mortality was observed at 80.6 though had been forecasted to be 48.7 (90% CI, 28.9, 76.2) (per 100,000). These findings of excess mortality steered the second phase, qualitative data collection and thematic analysis of six focus groups and ten interviews (46 total participants) of Hurricane Michael survivors and responders on the changes to health that they experienced. Findings were that survivors endured prolonged depression, anxiety, PTSD, lingering impacts to their general well-being, extended service disruptions to infrastructure and schools, a housing crisis, and relied on social connections to emotionally support one another because the area had very few mental health providers. Lastly, a third phase of the study used a thematic analysis of the collected qualitative data to conduct a triangulation to explain root causes of excess mortality modeling findings and evaluate whether those results or the official fatality count of 50 deaths was a more accurate measurement of Hurricane Michael's impact on health. This revealed how for months to years post-storm, survivors had delays in accessing health care, particularly specialty care, due to the hurricane having destroyed healthcare infrastructure, leading to them traveled multiple counties or states away for care including for cancer treatment; thus clarifying the excess mortality occurring several months after Hurricane Michael and supporting it as an accurate health measure. This study demonstrated the capability of analyzing excess mortality on smaller, rural populations and highlighted the need to utilize it as another measure of a natural disaster's impact on health along with a fatality count. Furthermore, qualitative data can corroborate disaster-related statistical findings and provide contextually rich data which offer crucial insight; expanding disaster measures overall can elucidate how communities are impacted and recover, therefore growing the knowledge of how to bolster resilience to unavoidable events such as hurricanes.

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