Date of Award

January 2026

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Kai Chen

Second Advisor

Jennifer Marlon

Abstract

Introduction: Flood events due to heavy precipitation, hurricanes, rising sea levels, and overflowing rivers are increasing under climate change, resulting in both direct and indirect health impacts. This study investigates the relationship between excess flood mortality and flood risk perception at the U.S. county level. Methods: This study utilizes nationwide, county-level flood mortality data from 2018-2020 and flood risk perception survey data from 2024. We applied a generalized linear model to examine the association between the proportion worried about flooding and the excess flood mortality, while controlling for flood hazard exposure, poverty, disability, health uninsurance rate, and unmeasured spatial confounding through a thin plate spline. Results: We found a borderline significant positive association between risk perception and excess mortality (β = 0.118, p = 0.051). Clusters of high risk perception are located along the Gulf coast and the Atlantic coast, especially in states like Texas, Louisiana, and Florida. Areas with high excess mortality due to flooding are located in the Midwest, Great Lakes region, and near the Mississippi and Ohio rivers. Counties with high risk perception and low mortality rates are primarily located in Texas, Louisiana, Mississippi, and Florida, as well as along the Atlantic coast. Counties with low risk perception and high mortality are primarily located in the Great Lakes region, Midwest, and West. Conclusion: Flood risk perception is positively associated with flood mortality at the county level. Policymakers and public health agencies should consider risk perception as part of emergency preparedness and vulnerability indices. Future research is needed to more closely examine temporal relationships between flood events, risk perception, and health outcomes, as well as the role of structural and behavioral factors in the risk perception to mortality pathway.

Comments

This is an Open Access Thesis.

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