Differential and persistent risk of excess mortality from Hurricane Maria in Puerto Rico: a time-series analysis Prof Carlos Santos-Burgoa, MD, John.

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Differential and persistent risk of excess mortality from Hurricane Maria in Puerto Rico: a time-series analysis Prof Carlos Santos-Burgoa, MD, John Sandberg, PhD, Prof Erick Suárez, PhD, Ann Goldman-Hawes, PhD, Prof Scott Zeger, PhD, Alejandra Garcia-Meza, MPH, Prof Cynthia M Pérez, PhD, Noel Estrada-Merly, MS, Uriyoan Colón-Ramos, ScD, Prof Cruz María Nazario, PhD, Elizabeth Andrade, DrPH, Amira Roess, PhD, Lynn Goldman, MD The Lancet Planetary Health Volume 2, Issue 11, Pages e478-e488 (November 2018) DOI: 10.1016/S2542-5196(18)30209-2 Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 1 Age-standardised and age-specific monthly mortality by year in Puerto Rico 2017–18 estimates are presented under both the census and displacement scenarios. (A) Age-standardised mortality by month from July to February for each year from 2010–11 to 2017–18. (B) Age-specific mortality from July to February for each year from 2010–11 to 2017–18. The Lancet Planetary Health 2018 2, e478-e488DOI: (10.1016/S2542-5196(18)30209-2) Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 2 Age-standardised monthly mortality by sex in Puerto Rico Age-standardised monthly mortality by sex from July, 2010, to February, 2018. 2015 is used as the standard population under the census and displacement scenarios. The Lancet Planetary Health 2018 2, e478-e488DOI: (10.1016/S2542-5196(18)30209-2) Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 3 Percentage increase in crude mortality by municipality in Puerto Rico Estimated increase in crude mortality from September, 2017, to February, 2018, relative to mean mortality in the same period in 2015–16 and 2016–17 under the displacement scenario. The Lancet Planetary Health 2018 2, e478-e488DOI: (10.1016/S2542-5196(18)30209-2) Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 4 Age-standardised mortality by municipal SEI tertiles in Puerto Rico Age-standardised mortality by SEI from July, 2010, to February, 2018, using 2015 as the standard population. SEI=Municipal Socioeconomic Development Index. The Lancet Planetary Health 2018 2, e478-e488DOI: (10.1016/S2542-5196(18)30209-2) Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 5 Observed and predicted deaths by month in Puerto Rico Model 3-based mortality estimates for the monthly and trigonometric forms from July, 2010, to August, 2017. The Lancet Planetary Health 2018 2, e478-e488DOI: (10.1016/S2542-5196(18)30209-2) Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions