Health Care Access and Health Indicators in Puerto Rico Pre- and Post- Hurricane Maria: Behavioral Risk Factor Surveillance System (2015-2019).

Hurricane Maria is regarded as one of the worst natural disasters in United States history as it devasted Puerto Rico (PR) in September 2017. This study compared population-based key health indicators among PR residents pre-and post-Hurricane Maria. We examined Behavioral Risk Factor Surveillance System (BRFSS) PR data from five survey years, including pre-and post-Hurricane Maria: 2015 (N = 4556), 2016 (N = 5765), 2017 (N = 4462), 2018 (N = 4814), and 2019 (N = 4958). The sample consisted of non-institutionalized adults aged ≥ 18 years with access to a landline or a cellular telephone. Using logistic regression we compared health care utilization, health behaviors, and outcomes pre-and post-Hurricane Maria. Models adjusted for age, sex, race, education, employment, income, and marital status (2017 = referent). Compared to 2017, post-hurricane participants were more likely to have a college degree or higher, be currently employed, and not married/partnered. Post-hurricane, participants were less likely to have health insurance coverage (2018 AOR, 95% CI: 0.75, 0.58-0.97) and had lower rates of diabetes (2018 AOR: 0.82, 0.70-0.96). The odds of being overweight/obese were lower pre-hurricane compared to 2017 (2015 AOR, 95% CI: 0.88, 0.79-0.97). There was no statistically significant difference in health behaviors across survey years. Results may suggest that PR residents with lower socioeconomic status and/or chronic illness were more likely to emigrate, resulting in a compositional change in the population post-hurricane. This analysis highlights the need for long-term follow-up of PR residents to better determine the impact of Hurricane Maria, and adequately design public health programs to address healthcare needs, access, and outcomes.