title: High-Amplitude Atlantic Hurricanes Produce Disparate Mortality in Small, Low-Income Countries.
abstract: Hurricanes cause substantial mortality, especially in developing nations, and climate science predicts that powerful hurricanes will increase in frequency during the coming decades. This study examined the association of wind speed and national economic conditions with mortality in a large sample of hurricane events in small countries.
  
  
  
  Economic, meteorological, and fatality data for 149 hurricane events in 16 nations between 1958 and 2011 were analyzed. Mortality rate was modeled with negative binomial regression implemented by generalized estimating equations to account for variable population exposure, sequence of storm events, exposure of multiple islands to the same storm, and nonlinear associations.
  
  
  
  Low-amplitude storms caused little mortality regardless of economic status. Among high-amplitude storms (Saffir-Simpson category 4 or 5), expected mortality rate was 0.72 deaths per 100,000 people (95% confidence interval [CI]: 0.16-1.28) for nations in the highest tertile of per capita gross domestic product (GDP) compared with 25.93 deaths per 100,000 people (95% CI: 13.30-38.55) for nations with low per capita GDP.
  
  
  
  Lower per capita GDP and higher wind speeds were associated with greater mortality rates in small countries. Excessive fatalities occurred when powerful storms struck resource-poor nations. Predictions of increasing storm amplitude over time suggest increasing disparity between death rates unless steps are taken to modify the risk profiles of poor nations. (Disaster Med Public Health Preparedness. 2016;10:832-837).
authors: 1University of Massachusetts Medical School,Worcester,Massachusetts.
authors: Caleb
authors: C
authors: Dresser
authors: 2Department of Quantitative Health Sciences,University of Massachusetts Medical School,Worcester,Massachusetts.
authors: Jeroan
authors: J
authors: Allison
authors: 3Department of Emergency Medicine,University of Massachusetts Medical School,Worcester,Massachusetts.
authors: John
authors: J
authors: Broach
authors: 3Department of Emergency Medicine,University of Massachusetts Medical School,Worcester,Massachusetts.
authors: Mary-Elise
authors: ME
authors: Smith
authors: 3Department of Emergency Medicine,University of Massachusetts Medical School,Worcester,Massachusetts.
authors: Andrew
authors: A
authors: Milsten
mesh_terms: D016010:Binomial Distribution; D055867:Cyclonic Storms / Q000401:mortality* / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data*; D006801:Humans; D011203:Poverty / Q000706:statistics & numerical data; D012959:Socioeconomic Factors
keywords: climate change; disaster; hurricane; mortality; poverty