title: Hurricane Isabel-related mortality--virginia, 2003.
abstract: BACKGROUND
  Hurricane Isabel had a massive negative environmental, public health, and economic impact; Virginia bore the highest death toll (32) among nine states affected by this storm. A descriptive mortality analysis was conducted to identify modifiable risk factors and corresponding injury prevention measures that might mitigate future natural disaster-related morbidity and mortality in Virginia.
  
  
  METHODS
  Information for the decedents, including demographic data, health status, and injury circumstances, was collected from the records of the Virginia Office of the Chief Medical Examiner and Office of Vital Records/Health Statistics. Criteria from the National Hurricane Center were used to classify deaths as direct or indirect. Storm assessments and emergency-response reports were also reviewed.
  
  
  RESULTS
  A total of 32 deaths associated with Hurricane Isabel occurred in several densely populated localities in southeastern and central Virginia. The median age of decedents was 48 years (range: 7-85 years). A disproportionately higher mortality (21 [66%] of 32) occurred among persons older than 45 years (Virginia 2000 Census data). Twelve deaths were directly caused by environmental factors related to the storm (eg, seven drowning deaths and five traumatic head injuries from falling trees). Twenty deaths were indirectly associated with the storm and its effects: six fatal motor vehicle crashes, five related to clean-up operations, seven associated with power outages, and two stress-related (ie, myocardial infarction and suicide). The presence of alcohol or drugs was observed in 9 (28%) of 32 deaths.
  
  
  CONCLUSIONS
  Classifying deaths as direct or indirect facilitates better target interventions on the basis of the identification of modifiable risk factors underlying hurricane-associated fatal injuries. Public education messages that reinforce avoidance of use of alcohol and drugs during natural disaster situations might reduce risk for injury.
authors.affiliation: US Public Health Service, Coordinating Office for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. ajani@cdc.gov
authors.forename: Asim A
authors.initials: AA
authors.lastname: Jani
authors.forename: M
authors.initials: M
authors.lastname: Fierro
authors.forename: S
authors.initials: S
authors.lastname: Kiser
authors.forename: V
authors.initials: V
authors.lastname: Ayala-Simms
authors.forename: D H
authors.initials: DH
authors.lastname: Darby
authors.forename: S
authors.initials: S
authors.lastname: Juenker
authors.forename: R
authors.initials: R
authors.lastname: Storey
authors.forename: C
authors.initials: C
authors.lastname: Reynolds
authors.forename: J
authors.initials: J
authors.lastname: Marr
authors.forename: G
authors.initials: G
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004190:Disasters; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D014768:Virginia / Q000453:epidemiology