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Emergency department visits associated with satellite observed flooding during and following Hurricane Harvey



Flooding following heavy rains precipitated by hurricanes has been shown to impact the health of people. Earth observations can be used to identify inundation extents for subsequent analysis of health risks associated with flooding at a fine spatio-temporal scale.


To evaluate emergency department (ED) visits before, during, and following flooding caused by Hurricane Harvey in 2017 in Texas.


A controlled before and after design was employed using 2016–2018 ED visits from flooded and non-flooded census tracts. ED visits between landfall of the hurricane and receding of flood waters were considered within the flood period and post-flood periods extending up to 4 months were also evaluated. Modified Poisson regression models were used to estimate adjusted rate ratios for total and cause specific ED visits.


Flooding was associated with increased ED visits for carbon monoxide poisoning, insect bite, dehydration, hypothermia, intestinal infectious diseases, and pregnancy complications. During the month following the flood period, the risk for pregnancy complications and insect bite was still elevated in the flooded tracts.


Earth observations coupled with ED visits increase our understanding of the short-term health risks during and following flooding, which can be used to inform preparedness measures to mitigate adverse health outcomes and identify localities with increased health risks during and following flooding events.

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Fig. 1: Study area map.
Fig. 2: Number of ED visits per million people for flooded and non-flooded tracts.
Fig. 3: Rate ratio for ED visits related to each outcome for flood period (09-26-2017 to 9-13-2017), post-flood 1 (09-14-2017 to 10-13-2017) and post-flood 2 (10-14-2017 to 12-30-2017).
Fig. 4: Rate ratio for ED visits related to each outcome during the flood period in the low, moderate, and highly flooded census tracts compared to the non-flooded census tracts.
Fig. 5: Rate ratio for ED visits related to each outcome during the post-flood 1 in low, moderate, and highly flooded census tracts compared to the non-flooded census tracts.


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The authors appreciate Dr Thomas Pingel, Department of Geography, Virginia Polytechnic Institute and State University for his support in providing computational resources for running our models. Authors are also grateful to Suwei Wang, Department of Population Health Sciences, Virginia Polytechnic Institute and State University for her guidance in implementing the models used in the study.


This study was supported by the National Aeronautics and Space Administration (NASA) Applied Sciences Program Grant #80NSSC18K1594.

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J.G., B.Z., S.S., and B.R. designed the study. B.R. performed the data analysis with the supervision of J.G., B.Z., and K.K. Authors M.J., and L.D. contributed to the data resources required for the paper. B.R. wrote the manuscript with support from J.G. All authors discussed the results and commented on the manuscript.

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Correspondence to Julia M. Gohlke.

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Ramesh, B., Jagger, M.A., Zaitchik, B. et al. Emergency department visits associated with satellite observed flooding during and following Hurricane Harvey. J Expo Sci Environ Epidemiol 31, 832–841 (2021).

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  • Exposure modeling
  • Epidemiology
  • Geospatial analyses
  • Population-based studies
  • Health studies


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