- Article
10 Pages
Introduction: North Atlantic hurricanes have intensified over recent decades, contributing to excess mortality, particularly among lower-income populations residing in coastal regions. However, the differential impact of hurricane intensity on mortality rates by income and education levels remains poorly understood. Methods: A population-based study was conducted using the North Atlantic Accumulated Cyclone Energy (ACE) index to assess associations with annual region- and sex-specific all-cause mortality rates (ages 20–84 years) across 279 counties in the southeastern United States from 2014 to 2022. The analyses were carried out for nine years; the total number of observations in the model for the 279 counties was 5022 (i.e., 279 counties × 9 years × 2 sexes). Associations were adjusted for covariates and were conducted using negative binomial regression, with autocorrelative residuals. Counties were stratified by pairs of income and education levels (i.e., low income–low education; high income–high education; low income–high education and high income—low education). ACE periods were classified as normal, above normal (≥126 × 104 kt2), and extreme (≥160 × 104 kt2). Results: The adjusted relationship between ACE and mortality was linear. Without stratification of income and education, extreme ACE periods were associated with increased all-cause mortality [rate ratio (RR) 1.056; p < 0.001] compared to normal ACE periods. Stratified analyses revealed that all income and education levels exhibited significant associations between extreme ACE and mortality, with the strongest for the high-income and high-education group (RR 1.097; p < 0.001). Insignificant associations were observed in counties with other income–education combinations. This pattern may reflect the coastal concentration of high-income, high-education counties, leading to greater hurricane exposure. Conclusions: Hurricane-related mortality varies by combined income and education levels, with elevated risk in coastal counties with higher socioeconomic status. Further research is warranted to explore cause-specific mortality and refine public health interventions based on socioeconomic vulnerability.
Challenges
3 October 2026



