Use of death counts from vital statistics to calculate excess deaths in Puerto Rico following Hurricane Maria

The official death toll for Hurricane Maria, which devastated Puerto Rico on September 20, 2017, has remained at 64 since December 29, 2017. Accurate estimates of deaths from environmental disasters are important for informing rescue, recovery, and policy decisions.

Using preliminary death counts through October 2017, excess deaths related to the hurricane were estimated at 1085. However, other estimates suggest that the number of excess deaths may be as high as 4645. The variance in estimates is due to differences in methodology. The official government death toll includes only 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 medical care). Estimates of excess deaths address both direct and indirect deaths and typically use either death counts from government agencies or surveys, which are susceptible to larger margins of error. We calculated the number of excess deaths following Hurricane Maria through December 2017, using death counts from vital statistics records, updating a previous estimate.