Commissioned by Governor Rosselló and carried out by the Milken Institute School of Public Health at George Washington University, the study found that the death toll was considerably higher than original reports.
The Puerto Rican government said the storm caused 64 deaths.
Almost 3,000 people died in Puerto Rico in the chaotic, grueling aftermath of Hurricane Maria, a toll that far exceeds the original estimates, according to a new study.
Last October, Trump visited Puerto Rico. "I think the lesson is to anticipate the worst". "But if you look at a real catastrophe like Katrina, and you look at the tremendous hundreds and hundreds and hundreds of people that died, and you look at what happened here with, really, a storm that was just totally overpowering - nobody has ever seen anything like this", he said.
"We are hopeful that the government will accept this as an official death toll", she said.
The researchers found that the risk of death was 45 per cent higher for those living in impoverished communities, and that men over 65 saw a continuous elevated risk of death.
Researchers hope to continue their research, interviewing families of those who died to better understand how the hurricane impacted their deaths.
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Puerto Rico Governor Ricardo Rossello immediately announced he was raising the official count of the death toll. "What is your death count, as of this moment - 17?"
In addition to estimating the excess deaths, the team also sought to identify flaws in mortality surveillance and communications systems and to offer recommendations aimed at helping Puerto Rico - and the mainland US - establish better methods for disaster preparedness and response.
Among the problems researchers identified: a lack of training for doctors about reporting on hurricane death counts, poor communication between central and local governments; and a lack of proper planning by both the Puerto Rican and federal governments for a disaster as large as Maria.
Thus, like other jurisdictions that are part of the USA, the death certification process can lead to an undercount of deaths related to disasters like Hurricane Maria.
Researchers said they adjusted for various factors that could account for fluctuations in mortality, most notably the population flux from some 241,000 residents who fled the island in the immediate aftermath of the storm. They also reviewed mortality data, including deaths by age, sex and municipality of residence, from July 2010 to February 2018. And in May, a Harvard study published by The New England Journal of Medicine estimated that the mortality rate ranged from about 800 to more than 8,000, with a midpoint estimate of 4,645.
The study also found that government emergency plans in place when Maria hit were not designed for hurricanes greater than a Category 1. "If enacted, the recommendations of this report could help save lives in Puerto Rico and beyond". The island is trying to restructure a portion of its more than $70 billion public debt amid a 12-year recession.