Floods and cause-specific mortality in the United States applying a triply robust approach

Lingzhi Chu, Joshua L. Warren, Erica S. Spatz, Sarah Lowe, Yuan Lu, Xiaomei Ma, Joseph S. Ross, Harlan M. Krumholz and Kai Chen ()
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Lingzhi Chu: Yale School of Public Health
Joshua L. Warren: Yale School of Public Health
Erica S. Spatz: Yale-New Haven Hospital
Sarah Lowe: Yale School of Public Health
Yuan Lu: Yale-New Haven Hospital
Xiaomei Ma: Yale School of Public Health
Joseph S. Ross: Yale-New Haven Hospital
Harlan M. Krumholz: Yale-New Haven Hospital
Kai Chen: Yale School of Public Health

Nature Communications, 2025, vol. 16, issue 1, 1-9

Abstract: Abstract The health impact of floods has not been well characterized. This study evaluated long-term associations between cause-specific mortality rates and county-level monthly flood days (excluding coastal floods caused by tropical storms) in the post-flood year in the contiguous U.S., using a triply robust approach incorporating propensity score, counterfactual estimation, and confounder adjustment. Death records came from the CDC National Center for Health Statistics (2001-2020) and floods came from the NOAA Storm Events Database (2000-2020). We found that one flood day was associated with 8.3 (95% CI: 2.5 to 14.1) excess all-cause deaths per 10 million individuals, 3.1 due to myocardial infarction, 2.4 due to respiratory diseases, and 5.9 due to external causes. From 2001 to 2020, 22,376 (95% CI: 6,758 to 37,993) all-cause deaths were attributable to floods. Our findings highlight the long-term health risks after floods, and a need for measures to reduce these risks.

Date: 2025
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DOI: 10.1038/s41467-025-58236-0

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