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Effects of a natural disaster on mortality risks over the longer term


Exposure to disasters and other extreme events is rising across the globe, but the impact on long-term mortality risks of affected populations is not established. We examine how mortality and individual-specific traumatic exposures at the time of the disaster affect mortality risks of survivors over the subsequent ten years, using data from Aceh, Indonesia, collected before and after the 2004 Indian Ocean tsunami. Across communities, the higher the percentage of individuals killed in the tsunami, the lower the mortality rate for adults over the subsequent decade. However, among older adults post-disaster mortality is elevated for males with poor post-tsunami psychosocial health and for females whose spouse died in the tsunami. Individual-specific tsunami exposures do not affect the mortality of younger adults within the ten-year time frame. Whereas positive mortality selection is evident for all adults, scarring is evident only for older adults and is large enough to substantively counteract the reductions in risk from positive mortality selection.

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Fig. 1: Relationship between community-level tsunami mortality and percentage of tsunami survivors who died between 2005 and 2015.

Data availability

The public-use STAR microdata are available at All data that support the findings of this study are available from the corresponding author ( upon request.

Code availability

All programs that support the findings of this study are available from the corresponding author upon request.


  1. 1.

    Vaupel, J., Yashin, A. & Manton, K. Debilitation’s aftermath: stochastic process models of mortality. Math. Popul. Stud. 1, 21–48 (1988).

    Article  Google Scholar 

  2. 2.

    Deschenes, O. & Moretti, E. Extreme weather events, mortality, and migration. Rev. Econ. Stat. 91, 659–681 (2009).

    Article  Google Scholar 

  3. 3.

    Chen, J. et al. Heatwave and elderly mortality: an evaluation of death burden and health costs considering short-term mortality displacement. Environ. Int. 115, 224–342 (2018).

    Google Scholar 

  4. 4.

    Kishore, N. et al. Mortality in Puerto Rico after Hurricane Maria. N. Engl. J. Med. 379, 162–170 (2018).

    Article  Google Scholar 

  5. 5.

    Vaupel, J. & Yashin, A. Heterogeneity’s ruses: some surprising effects of selection on population dynamics. Am. Stat. 39, 176–185 (1985).

    CAS  Google Scholar 

  6. 6.

    Campbell-Staton, S. et al. Winter storms drive rapid phenotypic, regulatory, and genomic shifts in the green anole lizard. Science 357, 495–497 (2017).

    CAS  Article  Google Scholar 

  7. 7.

    Donihue, C. M. et al. Hurricane-induced selection on the morphology of an island lizard. Nature 560, 88–91 (2018).

    CAS  Article  Google Scholar 

  8. 8.

    Grant, P. Evolution, climate change, and extreme events. Science 357, 451–453 (2017).

    CAS  Article  Google Scholar 

  9. 9.

    Cohen, A., Tillinghast, J. & Canudas-Romo, V. No consistent effects of prenatal or neonatal exposure to Spanish flu on late-life mortality in 24 developed countries. Demogr. Res. 20, 579–634 (2010).

    Article  Google Scholar 

  10. 10.

    Myrskylä, M., Mehta, N. K. & Chang, V. W. Early life exposure to the 1918 influenza pandemic and old-age mortality by cause of death. Am. J. Public Health 103, e83–e90 (2013).

    Article  Google Scholar 

  11. 11.

    Helgertz, J. & Bengtsson, T. The long-lasting influenza: the impact of fetal stress during the 1918 influenza pandemic on socioeconomic attainment and health in Sweden, 1968–2012. Demography 56, 1389–1425 (2019).

    Article  Google Scholar 

  12. 12.

    Brown, R. & Thomas, D. On the Long-Term Effects of the 1918 U.S. Influenza Pandemic Working Paper No. 569 (BREAD, 2019).

  13. 13.

    Ho, J., Frankenberg, E., Sumantri, C. & Thomas, D. Adult mortality five years after a natural disaster. Popul. Dev. Rev. 43, 467–490 (2017).

    Article  Google Scholar 

  14. 14.

    Subarya, C. et al. Plate-boundary deformation associated with the great Sumatra–Andaman earthquake. Nature 440, 46–51 (2006).

    CAS  Article  Google Scholar 

  15. 15.

    Titov, V., Rabinovich, A., Mofjeld, H., Thomson, R. & Gonzalez, F. The global reach of the 26 December 2004 Sumatra tsunami. Science 309, 2045–2048 (2005).

    CAS  Article  Google Scholar 

  16. 16.

    Lavigne, F. et al. Reconstruction of tsunami inland propagation on December 26, 2004 in Banda Aceh, Indonesia, through field investigations. Pure Appl. Geophys. 166, 259–281 (2009).

    Article  Google Scholar 

  17. 17.

    Monecke, K. et al. A 1,000-year sediment record of tsunami recurrence in northern Sumatra. Nature 453, 1232–1234 (2008).

    Article  Google Scholar 

  18. 18.

    Rubin, M. et al. Highly variable recurrence of tsunamis in the 7,400 years before the 2004 Indian Ocean tsunami. Nat. Commun. 8, 16019 (2017).

    CAS  Article  Google Scholar 

  19. 19.

    Degueldre, H., Metzger, J., Geisel, T. & Fleischmann, R. Random focusing of tsunami waves. Nat. Phys. 12, 259–262 (2016).

    CAS  Article  Google Scholar 

  20. 20.

    Umitsu, M., Tanavud, C. & Patanakanog, B. Effects of landforms on tsunami flow in the Plains of Banda Aceh, Indonesia, and Nam Khem, Thailand. Mar. Geol. 242, 141–153 (2007).

    Article  Google Scholar 

  21. 21.

    Elo, I. & Preston, S. Effects of early life conditions on adult mortality: a review. Popul. Dev. Rev. 58, 186–212 (1992).

    CAS  Google Scholar 

  22. 22.

    Currie, J. & Rossin-Slater, M. Weathering the storm: hurricanes and birth outcomes. J. Health Econ. 32, 487–503 (2013).

    Article  Google Scholar 

  23. 23.

    Jayachandran, S. Air quality and early-life mortality: evidence from Indonesia’s wildfires. J. Hum. Resour. 44, 916–954 (2009).

    Google Scholar 

  24. 24.

    Smith, J. P. & Thomas, D. Remembrance of things past: test–retest reliability of retrospective migration histories. J. R. Stat. Soc. A 166, 23–49 (2003).

    Article  Google Scholar 

  25. 25.

    McEwen, B. & Wingfield, J. The concept of allostasis in biology and biomedicine. Horm. Behav. 43, 2–15 (2003).

    Article  Google Scholar 

  26. 26.

    Stam, R. PTSD and stress sensitization: a tale of brain and body. Part 1: human studies. Neurosci. Biobehav. Rev. 31, 530–557 (2007).

    Article  Google Scholar 

  27. 27.

    Stam, R. PTSD and stress sensitization: a tale of brain and body. Part 2: animal models. Neurosci. Biobehav. Rev. 31, 558–584 (2007).

    Article  Google Scholar 

  28. 28.

    Boscarino, J. Posttraumatic stress disorder and mortality among U.S. Army veterans 30 years after military service. Ann. Epidemiol. 16, 248–256 (2006).

    Article  Google Scholar 

  29. 29.

    Frankenberg, E., Gillespie, T., Preston, S., Sikoki, B. & Thomas, D. Mortality, the family and the Indian Ocean tsunami. Econ. J. 121, F162–F182 (2011).

    Article  Google Scholar 

  30. 30.

    Dalgleish, T. in Post-traumatic Stress Disorders: Concepts and Therapy (ed. Yule, W.) 193–222 (Wiley, 1999).

  31. 31.

    Weathers, F. W. et al. The PTSD Checklist: Reliability, Validity, & Diagnostic Utility (presented at the annual meeting of the International Society for Traumatic Stress Studies, 1993).

  32. 32.

    Paxson, C., Fussell, E., Rhodes, J. & Waters, M. Five years later: recovery from post traumatic stress and psychological distress among low-income mothers affected by Hurricane Katrina. Soc. Sci. Med. 74, 150–157 (2012).

    Article  Google Scholar 

  33. 33.

    Waters, M. C. Life after Hurricane Katrina: the Resilience in Survivors of Katrina (RISK) Project. Sociol. Forum 31, 750–769 (2016).

    Article  Google Scholar 

  34. 34.

    Nobles, J., Frankenberg, E. & Thomas, D. The effects of mortality on fertility: population dynamics after a natural disaster. Demography 52, 15–38 (2015).

    Article  Google Scholar 

  35. 35.

    Clark, G., Frankenberg, E., Gillespie, T., Sumantri, C. & Thomas, D. Studying displacement after a disaster using large-scale survey methods: Sumatra after the 2004 tsunami. Ann. Am. Assoc. Geogr. 104, 594–612 (2014).

    Article  Google Scholar 

  36. 36.

    Frankenberg, E. et al. Mental health in Sumatra after the tsunami. Am. J. Public Health 98, 1671–1677 (2008).

    Article  Google Scholar 

  37. 37.

    Greene, W. The behaviour of the maximum likelihood estimator of limited dependent variable models in the presence of fixed effects. Econ. J. 7, 98–119 (2004).

    Google Scholar 

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This work was supported by the National Institute on Aging at the National Institutes of Health (grant numbers R01 AG031266 and R01 AG065395) and the Eunice Kennedy Shriver National Institute of Child Health and Development at the National Institutes of Health (grant numbers R01 HD052762, R21 HD051970 and P2C HD050924), the National Science Foundation (grant number CMS-0527763), the World Bank, the Hewlett Foundation, the MacArthur Foundation (grant number 05-85158-000) and the Wellcome Trust (grant number 106853/A/15/Z).

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All authors conceived the project. E.F. and D.T. conceptualized and conducted the analysis and wrote the paper. C.S. supervised data collection and contributed to interpretation of results.

Corresponding author

Correspondence to Elizabeth Frankenberg.

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The authors declare no competing interests.

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Frankenberg, E., Sumantri, C. & Thomas, D. Effects of a natural disaster on mortality risks over the longer term. Nat Sustain 3, 614–619 (2020).

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