Hurricanes, Neighborhood Disadvantage, and Cardiopulmonary Health in US Veterans.

Importance: Global climate change is increasing the frequency and severity of hurricanes, which are associated with adverse health outcomes. Veterans may be more susceptible to the health impacts of hurricanes because of prior military exposures. Objective: To determine whether hurricane exposure is associated with cardiovascular and respiratory events among US veterans. Design, Setting, and Participants: This retrospective cohort study included US veterans enrolled in Veteran Health Administration (VHA) primary care who lived in areas affected by Hurricane Sandy (2011-2013) or Hurricane Harvey (2016-2018). Data were analyzed between June 2024 and February 2026. Study areas were defined by VHA Veterans Integrated Service Networks (VISNs): VISN 1, 2, 3, 4, and 6 for Hurricane Sandy, and VISNs 16 and 17 for Hurricane Harvey. Exposure: Living in an area affected by Hurricane Sandy or Hurricane Harvey. Main Outcomes and Measures: Outcomes of interest were cardiovascular events (CVEs) and respiratory events (REs) that required urgent care and/or emergency department visits or in-patient admission. Associations between hurricane exposure and outcomes were estimated using Andersen-Gill Cox regression models. Results: Among veterans enrolled in VHA primary care, 1 468 774 lived in the study area during the quarter that Hurricane Sandy occurred, and 1 009 352 lived in the study area during the quarter that Hurricane Harvey occurred. After excluding veterans who were deceased at time of the hurricane or had incomplete data, the analytic cohort included 960 178 veterans exposed to Hurricane Sandy (mean [SD] age, 63 [16] years; 895 646 male [93.30%]) and 654 178 veterans exposed to Hurricane Harvey (mean [SD] age, 60 [16] years; 589 003 male [90.04%]). The analyses included 95 795 CVEs and 120 197 REs for the Hurricane Sandy cohort, and 91 774 CVEs and 98 660 REs for the Hurricane Harvey cohort. Higher levels of neighborhood disadvantage (for healthier veterans with highest levels of disadvantage, hazard ratios [HRs] for CVE were 1.75 [95% CI, 1.63-1.88] for Hurricane Sandy and 1.63 [95% CI, 1.48-1.80] for Hurricane Harvey; HRs for RE were 1.50 [95% CI, 1.43-1.58] for Hurricane Sandy and 1.67 [95% CI, 1.55-1.79] for Hurricane Harvey), age (among healthier veterans aged 60-70 years, HRs for CVE were 2.23 [95% CI, 2.11-2.35] for Hurricane Sandy and 4.12 [95% CI, 3.87-4.39] for those aged ≥70 years for Hurricane Harvey; HRs for RE among sicker veterans were 1.12 [95% CI, 1.08-1.16] for Hurricane Sandy and 1.31 [95% CI, 1.24-1.39] for Hurricane Harvey), and sex (among healthier female veterans, HRs for CVE were 0.52 [95% CI, 0.46-0.59] for Hurricane Sandy and 0.49 [95% CI, 0.44-0.53] for Hurricane Harvey; HRs for RE were 1.38 [95% CI, 1.32-1.43] for hurricane Sandy and 1.36 [95% CI, 1.31-1.41] for Hurricane Harvey) were associated with CVEs and REs in both cohorts. There were no associations between hurricane exposure and CVEs and REs after accounting for baseline differences between exposure regions. Conclusions and Relevance: This cohort study of 1 614 356 US veterans used an approach that addresses preexisting differences to isolate the association of hurricane exposure with CVEs and REs among veterans. Although changes in HRs specifically attributable to hurricane exposure were not significant, neighborhood disadvantage, advancing age, and sex remained independently associated with acute health events. These findings suggest that disaster preparedness policies should shift from a reactive model toward a longitudinal strategy that addresses baseline social determinants of health and regional environmental hazards.