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Cosmos Study - Collaboration

Hurricanes Have Minimal Influence on Sinus Infection Rates

March 27, 2025
Dual-Team Study
Team A:Brian C. Lobo, MDAvraham AdelmanEmily Higgs
Team B:Kersten Bartelt, RNJoe Deckert, PhD

Key Findings

  • Sinus infection rates in areas where hurricanes made landfall show minor fluctuations, but no consistent trends, in the six weeks following the storms, compared to equivalent time periods in previous and subsequent years.  
  • Hurricanes are most likely to make landfall during the same months that are typically associated with respiratory illness; that seasonality likely plays a much larger role in sinus infection rates. 

Hurricanes have been associated with a range of public health concerns, including respiratory illnesses due to mold exposure, infrastructure damage limiting healthcare access, and increased stress-related conditions.1,2 Previous studies have looked at increases in respiratory symptoms following specific hurricanes, but the overall impact of hurricanes on sinus infections remains unclear.3,4 Anecdotal reports suggest that more patients seek care for sinus infections after a hurricane, highlighting the need for further research on this potential connection. 

To assess whether hurricane-affected populations experienced an increase in sinus infections, we examined encounters for either acute or chronic sinus infections in the six-week period following landfall of hurricanes Ian (2022), Nicole (2022), Idalia (2023), and Debby (2024).5–8 We compared these periods to the same timeframe in the year before and after each hurricane. We compared Debby to the two years prior because it was too recent to compare to the year after. Our study population included residents of affected ZIP codes in Florida, Georgia, and South Carolina who had a healthcare encounter during the relevant study period. 

We found that the impact of hurricanes on sinus infection rates was minimal. Despite some minor fluctuations, we did not observe a consistent change in acute or chronic sinus infections in the weeks following any of the hurricanes studied compared to the years before and after. However, seasonal increases in sinus infection rates coincide with when hurricanes often make landfall and have a much more noticeable effect, as seen in Figures 1 and 2. 

Figure 1
Annual Comparisons of Acute Sinus Infections Post Hurricane by Hurricane Path
Annual Comparisons of Acute Sinus Infections Post Hurricane by Hurricane Path
Figure 1. Five-week rolling average of seasonal acute sinus infection rates in the geographic areas affected by hurricanes Ian, Nicole, Idalia, and Debby. 
Figure 2
Annual Comparisons of Chronic Sinus Infections Post Hurricane by Hurricane Path
Annual Comparisons of Chronic Sinus Infections Post Hurricane by Hurricane Path
Figure 2. Five-week rolling average of seasonal chronic sinus infection rates over time in the geographic areas affected by hurricanes Ian, Nicole, Idalia, and Debby. 

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 296 million patient records from 1,600 hospitals and more than 37,000 clinics from all 50 states, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson. 

References

  1. Azimi P, Allen J. Respiratory health harms often follow flooding—taking these steps can help. Harvard Health Publishing. November 9, 2022. Accessed March 6, 2025. https://www.health.harvard.edu/blog/respiratory-health-harms-often-follow-flooding-taking-these-steps-can-help-202211092848 
  2. BiologyInsights Team. Health risks from flooding after hurricanes. BiologyInsights. January 9, 2025. Accessed March 6, 2025. https://biologyinsights.com/health-risks-from-flooding-after-hurricanes/ 
  3. Rath B, Young EA, Harris A, et al. Adverse respiratory symptoms and environmental exposures among children and adolescents following Hurricane Katrina. Public Health Rep. 2011;126(6):853-860. doi:10.1177/003335491112600611 
  4. Oluyomi AO, Panthagani K, Sotelo J, et al. Houston hurricane Harvey health (Houston-3H) study: assessment of allergic symptoms and stress after hurricane Harvey flooding. Environ Health. 2021;20(1):9. Published 2021 Jan 19. doi:10.1186/s12940-021-00694-2 
  5. National Hurricane Center. Tropical Cyclone Report: Hurricane Ian. National Oceanic and Atmospheric Administration. Updated April 3, 2023. Accessed March 6, 2025. https://www.nhc.noaa.gov/data/tcr/AL092022_Ian.pdf 
  6. National Hurricane Center. Tropical Cyclone Report: Hurricane Nicole. National Oceanic and Atmospheric Administration. Updated March 17, 2023. Accessed March 6, 2025. https://www.nhc.noaa.gov/data/tcr/AL172022_Nicole.pdf 
  7. National Hurricane Center. Tropical Cyclone Report: Hurricane Idalia. National Oceanic and Atmospheric Administration. Updated February 13, 2023. Accessed March 6, 2025. https://www.nhc.noaa.gov/data/tcr/AL102023_Idalia.pdf 
  8. National Hurricane Center. Tropical Cyclone Report: Hurricane Debby. National Oceanic and Atmospheric Administration. Updated February 4, 2025. Accessed March 6, 2025. https://www.nhc.noaa.gov/data/tcr/AL042024_Debby.pdf. 

Data Definitions

Study period
Time periods differ by storm:
Ian: Landfall 9/18/22
  • 6-week period 9/16/2022–10/27/2022
Nicole: Landfall 11/10/22
  • 6-week period: 11/11/2022–12/22/2022
Idalia: Landfall 8/29/23
  • 6-week period: 9/1/2023–10/12/2023
Debby: Landfall 8/5/24
  • 6-week period: 8/9/2024–9/19/2024
Study population
Encounters with a patient whose last recorded address was in an affected ZIP code and one of the following states:
  • Ian: Florida
  • Nicole: Florida
  • Idalia: Florida, Georgia, South Carolina
  • Debby: Florida, Georgia, South Carolina
Outcomes
A diagnosis of acute sinus infection or chronic sinus infection
Affected ZIP codes
Ian: 32951, 32920, 32931, 32937, 32901, 32781, 32796, 32754, 32953, 97625, 32780, 32927, 32926, 32903, 32935, 32904, 32955, 32925, 34786, 32960, 32958, 32963, 32967, 34788, 34748, 32767, 34714, 32757, 32711, 34996, 34957, 33455, 34956, 34997, 34974, 34972, 32827, 34787, 32826, 32751, 32805, 32832, 32810, 32821, 32836, 32809, 32819, 32818, 34744, 34741, 31907, 34771, 34773, 32773, 32771, 33876, 32708, 32746, 32765, 32732, 12546, 34950, 34945, 34982, 34984, 34949, 32168, 32114, 32176, 32724, 32738, 32759, 32130, 32950, or 32949
Nicole: 32064, 32177, 33440, 32351, 32320, 33431, 34601, 33830, 34428, 33755, 32925, 32225, 32628, 32114, 32724, 32110, 33304, 32034, 34950, 32348, 33881, 32601, 34450, 34741, 32207, 33815, 34748, 33462, 33261, 32827, 32901, 32212, 32227, 34974, 34475, 32803, 33401, 33563, 33701, 33870, 32771, 32084, 34236, 34994, 32301, 33601, 32815, 33610, 32960, 33853, 32958, 32696, 32920, 33542, 30344, 32625, 30125, 32257, 34228, 32226, 33619, 35901, 33460, 32233, 32277, 33616, 33019, 34221, 33606, 34667, 34689, 33611, 32899, 32782, 32796, 32759, 32780, 32953, 32926, 32615, 34266, 33598, 33430, 33827, 34483, 33525, 33527, 32180, 33850, 34762, 32666, 34758, 32703, 32145, 32784, 34787, 33414, 33426, 32952, 32931, 32904, 33004, 33132, 33062, 33455, 32080, 32949, 34957, 33408, 32951, 33407, 33125, 32168, 33458, 32950, 34982, 33756, 33711, 33351, 34698, 34224, 33810, 34639, 33477, 34250, 34602, 34606, 32066, 32424, 32328, 32344, 32308, 32082, 32648, 32304, 34996, 32327, 33483, 33444, 33471, 34946, 34949, 33898, 32962, 32976, 33930, 33470, 33837, 32805, 32073, 32955, 32640, 34786, 32653, 32927, 32757, 32832, 32935, 32763, 32708, 34769, 33021, 34761, 32738, 32725, 32779, 32259, 32223, 32948, 33418, 32092, 33138, 33161, 33823, 33411, 32940, 32707, 33576, 33825, 32134, 32130, 32767, 33844, 34966, or 32967
Idalia: 33040, 33050, 33070, 33042, 34104, 33315, 33309, 33033, 33023, 33142, 33014, 33406, 33064, 33186, 34142, 34114, 33461, 33030, 33431, 33351, 33167, 33012, 33326, 33136, 33065, 33322, 33124, 33471, 33935, 33071, 33426, 33477, 33025, 33407, 33178, 33476, 34139, 34119, 34974, 33467, 34141, 33473, 33187, 32827, 32773, 34741, 34788, 32114, 32780, 32901, 32960, 34946, 34996, 32952, 32931, 32904, 33455, 32949, 32169, 32950, 34957, 32690, 32925, 32899, 32953, 33607, 34219, 34211, 34241, 33914, 34120, 33844, 33545, 33830, 32696, 34429, 34450, 33542, 33765, 33606, 33592, 33563, 33811, 33859, 33876, 34285, 33946, 33621, 33619, 32625, 34689, 34667, 33901, 33701, 33767, 33605, 34221, 33616, 34660, 34237, 33905, 33810, 33756, 34224, 34613, 33558, 33982, 33950, 33952, 33957, 34270, 33712, 33778, 33776, 33773, 32680, 34135, 34639, 33620, 34610, 36339, 33980, 34668, 33825, 34695, 33771, 33852, 34243, 34652, 33525, 34461, 33870, 33513, 34638, 33602, 34428, 33960, 34265, 34677, 34653, 33760, 34690, 32621, 33541, 32683, 34609, 34785, 33965, 33916, 33928, 33908, 33645, 33634, 34434, 34637, 33764, 33766, 34452, 33647, 33540, 32348, 32327, 32320, 32310, 32329, 32347, 32628, 32328, 32006, 32648, 32340, 32355, 32344, 32301, 32308, 32309, 32322, 32303, 32218, 32225, 32227, 32609, 32202, 32060, 32619, 32064, 32052, 31706, 31601, 31699, 31794, 31750, 31788, 31647, 31629, 31793, 31643, 31503, 31510, 31546, 31522, 31542, 31408, 30442, 30429, 29488, 30461, 30467, 30453, 31409, 29810, 30439, 31314, 31327, 31328, 31401, 29927, 30906, 30904, 30824, 29404, 29455, 29461, 29926, 29483, 29466, 29906, 29907, 29415, 29469, 29451, 29482, 29412, 29439, 29920, 29115, 29044, 29152, 29812, 29102, 29112, 29802, 29172, 29205, 29009, 29520, 29720, 29132, 29108, 29582, 29577, 29527, 29440, 29556, 29574, 29506, 29550, 29540, 29512, 23337, 23602, 23518, 23505, 23669, 23460, 23456, 33483, 33004, 33408, 33062, 33149, 33316, 33460, 226101, 34236, 33711, 32080, 32226, 32250, 32084, 28451, 28480, 28449, 28462, 29576, 28465, or 21843
Debby: 33607, 33762, 33701, 34243, 33982, 33907, 33913, 33881, 34604, 32310, 32329, 32827, 32773, 34788, 32114, 32901, 32960, 34946, 34104, 33315, 33309, 33033, 33142, 33014, 33406, 33064, 33186, 33040, 33050, 32225, 32609, 32218, 32222, 32226, 33830, 32696, 34429, 34450, 33542, 33765, 33606, 33592, 33563, 33811, 33859, 33876, 34285, 33946, 33616, 32347, 34741, 32780, 34996, 33440, 33431, 33461, 33037, 32060, 32177, 32091, 32034, 34474, 32095, 33480, 34114, 33042, 34108, 33140, 33430, 33025, 33458, 33009, 33410, 33133, 33436, 33426, 34139, 33404, 34142, 33128, 33060, 33619, 34689, 32625, 32925, 33901, 33767, 33605, 33602, 34221, 32899, 32953, 34141, 33034, 33187, 33041, 32327, 32328, 33052, 34498, 32680, 33712, 34695, 33771, 34461, 36339, 34610, 33770, 34639, 34135, 33620, 33558, 34428, 32006, 32341, 32355, 32344, 32301, 32308, 32628, 32309, 32303, 32320, 32346, 32340, 32312, 32920, 32751, 34758, 32118, 32708, 33124, 33065, 33935, 33070, 34660, 34237, 33905, 33810, 33756, 34224, 34613, 33914, 32952, 32931, 32904, 32830, 33455, 32949, 32951, 32169, 34787, 32950, 34957, 32690, 33477, 33178, 32250, 32055, 31706, 31601, 31699, 31510, 31522, 31408, 31409, 31794, 31750, 31503, 31539, 31524, 31533, 30144, 30474, 30442, 30417, 30467, 30439, 30453, 30461, 31527, 31328, 29582, 29506, 29404, 29512, 29577, 29810, 29907, 29483, 29926, 29455, 29466, 29461, 29488, 29576, 29572, 29440, 29920, 29412, 29482, 29451, 32080, 34145, 23081, 27982, 27959, 27915, 27931, 28516, 27943, 27968, 27949, 32244, 32227, 28480, 23451, 23607, 23443, 22511, 23324, 21843, 23501, 23480, 23651, 33460, 33316, 33149, 34974, 33483, 34236, 33711, 33004, 33408, 33137, 33435, 33132, 33062, 32084, 29915, or 29415
Acute sinusitis
A diagnosis with ICD-10-CM code J01*
Chronic sinusitis
A diagnosis with ICD-10-CM code J32*
Limitations
Idalia’s and Debby’s paths were through a part of Florida with less healthcare access than the paths of Ian and Nicole. For example, several of the counties in the north, closer to the panhandle, have encounter counts in the hundreds for those six months while Orlando has 1.2 million, and the surrounding counties have around 100,000.
Ian and Nicole were separated by about two months. The compounding effect of being in the path of both storms was not evaluated.