Assessment of Lightning Mortality in the United States from 1979 – 2022

doi:10.21203/rs.3.rs-4688957/v1

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Assessment of Lightning Mortality in the United States from 1979 – 2022

https://doi.org/10.21203/rs.3.rs-4688957/v1

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Climate change has been linked to an increased prevalence of lightning activity associated with hazardous storm formation. An increased frequency in lightning activity in the United States (US) would presumably increase the risk and incidence for lightning-related injuries and fatalities. Using cause of death data available from the US Centers for Disease Control and Prevention (CDC) via their WONDER online databases and the National Weather Service, the results showed a steady decline in the lightning-related mortality incidence and incidence rates in the US from 1979–2022. In the early 1980s, U.S. death rates were near four per 10 million, and are now near one per 10 million. Death rates in the American South are higher, but have also experienced improvement, having fallen from near six per 10 million in the early 1980s to two per 10 million in recent years. A limitation of this study is a lack of data on lightning-related injuries. Overall, the steady decline in lightning-related deaths in the US likely is related to a multitude of factors including early storm reporting, improved risk communication, improved public education regarding the hazard, increased urbanization and mechanization of outdoor work, improvements in emergency medical care, among other weather-related risk reduction strategies. These results highlight the success of risk reduction strategies for reducing lightning-associated mortality in the US while the threat of hazardous lightning has likely continued to increase.

Fatalities

Mortality

Lightning

Trends

United States

Storms

The Centers for Disease Control and Prevention (CDC) reports there were 444 deaths attributable to lightning strikes from 2006 through 2021 in the United States (CDC 2024a) or 27.75 deaths per year. The latest 10-year average for lightning mortality is 21 deaths per year for the 2014–2023 period (National Weather Service 2024). The decreased incidence is on track with the slight, but steady, decrease observed by Duclos and Sanderson (1990) when the incidence of lightning-related deaths fell from approximately 130 to 90 deaths per year between 1968 and 1985.

The decreased incidence in lightning-related mortality in the US is notable given presumed changes in climate that may have increased the frequency of hazardous lightning. Between 25 million and 40 million lightning strikes hit the ground in the United States annually according to the National Weather Service (2024) and CDC (2024a), respectively. The prevalence of these lightning strikes is presumed to be increasing as both air temperatures (Williams et al. 2005; Price 2008; Romps et al. 2014; Price and Rind 2024) and nitrous oxides have increased (Schumann and Huntrieser, 2007; Banerjee et al. 2014). Some uncertainty remains regarding if there has been or will be increased lightning prevalence everywhere globally due to the complexity involved with lightning formation with respect to changes in local atmospheric chemistry. For example, there may be decreases in lightning strikes in tropical regions, while there may be increases in lightning in non-tropical regions (Finney et al. 2018; Janssen et al. 2023).

For the continental United States, Romps et al. (2014) predicted a 12% increase in lightning strikes for every one degree increase in global average air temperature. While not yet able to be thoroughly tested, only recently has a baseline been able to be set for characterizing the number of cloud-to-ground (CG) flashes and number of ground strikes points for the contiguous US (Vagasky et al. 2024). Vagasky et al. (2024) estimated the average number of CG flashes as 23.4 million per year with an average of 36.8 million ground contacts per year.

Given the ongoing prevalence of the lightning hazard, and potential increase for lightning strikes in portions of the US, we aim to present the results of lightning mortality using rates and trends to enable comparison with historical epidemiological studies on the topic. While there are valuable detailed analyses available for the 466 lightning fatalities that occurred in the U.S. from 2006 through 2022 (Jensenius, 2023) as well as mortality incidence data on citizen-oriented web sources (CDC 2024a; NWS 2024), there is limited reporting on mortality rates, which adjust for population size. For building upon earlier epidemiological studies (Duclos and Sanderson 1990; Curran et al. 2000; Adekoya and Nolte 2005), we present mortality rates by year for examining and comparing trends.

Mortality data were extracted from the CDC using their publicly accessible “Wide-ranging ONline Data for Epidemiologic Research” (WONDER) database (CDC 2024b). The data were retrieved from WONDER using the Underlying Cause of Death files contained within the database. For this study, there were four data retrievals. Two data retrievals were related to the 1999–2020 timeframe and the other two retrievals were regarding the 1978–1998 timeframe. For each timeframe, there was one retrieval for lightning mortality data for the entire US grouped by year, and there was one retrieval for lightning mortality data grouped by Census region (or region) and year.

The lightning mortality and total population data for 1999–2022 were extracted from the 1999–2020 Underlying Cause of Death by Bridged-Race Categories and the 1998–2022 Underlying Cause of Death by Single-Race Categories. This mortality database uses coding specific to the International Classification of Diseases of Diseases and Related Health Problems, 10th Revision (ICD-10). Data for 1999–2020 were extracted for deaths coded by ICD-10 as X33 (victim of lightning), which is contained within X30-39 (exposure to forces of nature). The mortality data for 1978–1998 were extracted from the 1968–2016 Compressed Mortality database, upon selecting for mortality data from 1979–1998 with ICD 9th Revision (ICD-9) codes. Data were extracted for 1978–1998 cases coded by ICD-9 as E907 (lightning), which is contained in E900-E909 (accidents due to natural and environmental factors). For data extracted from CDC WONDER, if any cell resulted in fewer than 10 deaths, the data were suppressed in accordance with CDC policy.

Data were analyzed with Stata 15. Crude mortality rates per 10 million persons were calculated as the number of deaths divided by the population at-large multiplied by 10 million. For years with death counts below 16, CDC WONDER reported the crude rate results as unstable due to having poor reliability (Brillinger 1986). Despite this limitation, the mortality rates were calculated for inclusion in the regression models and averages.

Scatterplots incorporating linear regression analysis results were generated for visualizing and evaluating the change in lightning mortality rates by year for the whole US and for the US-South Census Region. Given the low prevalence (less than 10 cases) of lightning-related deaths by year in Census regions beyond the South, most Census region data by year were suppressed, which prevented time-trend analyses of lightning mortality by regions other than the South. In the years of 2011 and 2021, there were less than 10 deaths from lightning in the South, resulting in suppressed data in CDC WONDER. Given that fatality data by state, which corresponded with CDC WONDER data, are available from the National Weather Service, the results for 2011 and 2021 were able to be determined and incorporated. (National Weather Service 2024b).

For analyzing the data, scatterplots with lines of best fit were able to be generated for the aggregated data (1978–2022) and for the data obtained by ICD-9 (1978–1998) and data obtained by ICD-10 and the National Weather Service (1999–2022). Annual and average mortality rates for the U.S. and South Census region were obtained for 1978–2022, 1978–1998, and 1999–2022. Paired t-tests comparing lightning mortality rates by year between the South Region and U.S. inclusive of the South, were performed.

The frequency of lightning fatalities in the US significantly declined in the period of study (1979 to 2022). In 1979, there were 87 deaths; whereas, in recent years, there were 17 deaths in 2020, 11 in 2021, and 19 in 2022. The National Weather Service (2024b) reports 14 deaths in 2023. Lightning fatalities are remarkably lower now than early in the observation period, such as when there were 100 deaths in 1982, which represented a lightning-specific mortality rate of 4.32 deaths per 10 million persons. For comparison, the 2021 and 2022 mortality rates from lightning were 0.45 and 0.69 deaths per 10 million, respectively.

The mean number of lightning deaths (Table 1) and lightning-specific mortality rates (Table 2) are appreciably lower in the 1999–2022 period relative to the 1979–1998 period. Across US Census regions, the US South has had the highest frequency of lightning deaths. From 1979–2022, the mean number of deaths by year for the US South has been slightly above half of the total US. In recent years, the lowest frequency of lightning mortality for the US South has been five deaths. By comparison, the lowest frequency of deaths in 1979–1998 was 23.

Table 1

Summary statistics for the frequency of lightning deaths in the United States (US) and the US South Census Region by time period.
Time Period	Region	n (years)	Mean	Median	Min.	Max
1979–2022	Entire US	44	55.1	51.5	15	100
1979–2022	US South	44	29.6	30.5	5	58
1979–1998	Entire US	20	79.8	83	53	100
1979–1998	US South	20	41.5	40	23	58
1999–2022	Entire US	24	34.9	29.5	15	66
1999–2022	US South	24	19.8	17.5	5	40

For comparing the US South versus the entire USA, the mean lightning mortality rate was significantly higher (p < 0.0001) in the US South Census region relative to the overall US according to three paired t-tests from 1979–2022, from 1979–1998, and from 1999–2022 (Table 2). Upon performing f-tests associated with six linear regression analyses, all tests demonstrate significant (p < 0.0001) declines in the annual lightning mortality rates for the US (Fig. 1) and US South Census region (Fig. 2) across the 1979–2022 period, and by the 1979–1998 and 1999–2022 periods (Fig. 3; Fig. 4).

Table 2

Summary statistics for the lightning-specific mortality rates in the United States (US) and the US South Census Region by time period.
Time Period	Region	Mean Mortality Rate per 10 Million	S.E. of Mean Mortality Rate	p
1979–2022	Entire USA	2.10	0.18	< 0.0001
1979–2022	US South	3.22	0.30	< 0.0001
1979–1998	Entire USA	3.24	0.16	< 0.0001
1979–1998	US South	4.94	0.31	< 0.0001
1999–2022	Entire USA	1.15	0.11	< 0.0001
1999–2022	US South	1.78	0.20	< 0.0001

The scatterplots demonstrate that prior to 1990, the US was experiencing lightning mortality rates near three to four deaths per 10 million; however, by 2008, the rate dropped to below or near one death per 10 million (Fig. 1). A similar pattern existed for the U.S. South Census region, however, the rates were approximately double the US rate (Fig. 2). As the US and South region are now approaching lightning fatality rates near zero per 10 million, the regression lines for the lightning fatality rates by year have somewhat flattened in the 1999–2022 period relative to the steep declines observed from 1979–1998 (Fig. 3; Fig. 4).

Consistent with prior research, the frequency of lightning-related deaths has continued to decline across the US overall and US South over time (Duclos and Sanderson 1990; Curran et al. 2000; Adekoya and Nolte 2005; Holle et al. 2005; Jensenius and Franklin 2014; Jensenius et al. 2023). The declines in lightning deaths by year are particularly notable given increases in the US and Southern US populations, which are reflected by the decreases in the mortality rates. Furthermore, these decreases are potentially more notable if there has been a true increase in the frequency of cloud-to-ground lightning attributable to warmer air temperatures (Williams et al. 2005; Price 2008; Romps et al. 2014; Yair 2018; Price and Rind 2024). While there may have been fewer lightning fatalities during the COVID-19 pandemic in 2020 and 2021, which speculatively could be attributable to different outdoor- and work-related human behaviors, the trend towards a lower mortality rate was already apparent prior to 2020. Furthermore, in 2022 and 2023, the reduced frequency of lightning mortality for the entire US population was sustained with 17 and 13 deaths, respectively (National Weather Service 2024b).

The findings demonstrate significant public health achievements associated with the ongoing and historical activities of the National Oceanic and Atmospheric Administration (NOAA) and National Weather Service, Lightning Safety Alliance, U.S. National Lightning Safety Council, emergency medical care providers, the individuals part of these organizations, among others. Globally, the high-income countries have had annual lightning mortality rates below 0.3 victims per million (Ströhle et al. 2018). The US results illustrate a mean mortality rate of 0.115 per million from 1999 through 2022 (Table 2). While these improvements have been notable, the hazard remains and warrants continued vigilance with respect to monitoring and active preventive measures. Targeted and ongoing education for the general public, and males in particular, remains warranted. Furthermore, education for younger populations and families ought to continue for maintaining awareness of the danger presented by outdoor activities proximal to thunder.

In a recent case series analysis of fatal lightning victims from 2006 through 2022, Jensenius (2023) noted that males represented 80% of all the victims, and 90% of the lightning victims when stratifying for those who were engaged in fishing, work, and sports, during the period. Among all the victims, 63% were engaged in leisure or recreational activities at the time of death, including water-related activities (fishing, beach, boating, and swimming), outdoor sports, and camping. In addition to leisure activities, work-related fatalities have consistently represented about 18.5–25% of the lightning mortality in the US since the 1980s (Duclos and Sanderson 1990; Adekoya and Nolte 2004). From 2006 through 2022, 19% of the lightning deaths were work-related with farming/ranching, roofing, and construction being the highest risk groups (Jensenius 2023). The results of this case series remain useful for informing ongoing education and outreach.

While emergency medical care for victims has been considerable and has reduced lightning mortality (Zimmerman et al. 2002), the Wilderness Medical Society emphasizes prevention in their practice guidelines for preventing and treating lightning injuries (Davis et al. 2014). The guidelines embrace the National Weather Service maxim, “When the thunder roars, go indoors.” The guidance also clarifies that estimating a safe distance from the time between hearing thunder and seeing a lightning flash has contributed to false presumptions of safety. Accordingly, the prevailing guidance is as follows, “Individuals should wait a minimum of 30 minutes after hearing the last thunderclap before resuming outdoor activity. Waiting 30 minutes should allow for the trailing edge of the thunderstorm to move the estimated 10 miles needed to establish an appropriate buffer zone.” (Davis et al. 2014). Furthermore, the time necessary to evacuate at-risk locations should be incorporated into lightning action plans, with adults (teachers, lifeguards, sporting officials/coaches, etc.) assuming responsibility for the safety of any children (Zimmerman et al. 2002).

Some limitations of our study relate to the focus on mortality. Specifically, injury is also an important health-relevant outcome from lightning strikes. Previous research estimates 70–90% of victims from lightning will survive; however, many (76%) of the survivors will endure long-term sequelae (Ritenour et al. 2008). The lightning victim survival rates in high-income countries are estimated to be near 90% (Holle et al. 2021), and if that estimate remains reliable, then approximately 170 and 130 persons were struck by lightning in 2022 and 2023, respectively, based upon an extrapolation from the 17 and 13 deaths observed in 2022 and 2023 (National Weather Service 2024b). Additionally, if 130 to 170 persons in each of the last two years experienced long-term sequelae in 76% of those events, then it is plausible that in the last two years there have also been approximately 99 to 129 persons in the last two years who have had, or continue to have, long-term adverse health effects from those events. The sequalae likely include disorders with their central nervous system, vision/eyes, skin, muscles, and more (Ritenour et al. 2008). For comparison, using 2019 data, the National Weather Service estimated 243 injuries from 27 lightning deaths (National Weather Service 2024c).

Another limitation of our data analysis focusing on annual US mortality is that it could lead to an underestimation of the lifetime risk of being struck by lightning or dying from a lightning strike. While the annual and lifetime rates are considerably higher for males, in 2008, the risk for the average US person being struck in a lifetime was one in 3,000, and the risk of death was one in 35,000 (Ritenour et al. 2008). Using data through 2018, the National Weather Service (2024c) estimated the lifetime risk (80 years) of being struck at one in 15,300. Using similar extrapolations, if 27 deaths were linked to a lifetime risk of 1:15,300 being struck in 2018, then if the 17 deaths remained constant from 2022 into the future, the updated lifetime risk in the US would be approximately one lighting strike per 24,300 persons, in which nearly 10% of those persons would succumb to the lightning. These risks are considerably higher for males and persons in the US South. Modern lifetime lightning strike risk estimates are reliant on the assumption that the incidence of lightning strikes will remain at all-time lows.

Potential barriers for sustaining these all-time low lightning mortality rates in the US or preventing the further reduction in lightning injuries and mortality in the US include (1) changes in the climate and other atmospheric conditions that promote more lightning (Romps et al. 2014, Banerjee et al. 2014), (2) complacency or overconfidence by the most at-risk citizenry regarding the hazard (Casteel 2023), (3) increases in the number of unsheltered or poorly sheltered citizens (Settembrino 2017; Bezgrebelna et al. 2021; Richards and Kuhn (2023), and (4) changing population demographics that could impact public alerts, warning messages, and educational campaigns (Sadiq et a. 2023).

There was one documented lightning-related death in a homeless individual in the case series of lightning deaths for 2006 through 2022, which represented one (0.21%) case out of 466. Additionally, among work-related lightning victims, there has been overrepresentation of Hispanic workers in historical studies; whereby from 1995 to 2022, Hispanic workers represented nearly one-third of those work-related lightning deaths despite being 12% of the population at-risk (Adekoya and Nolte 2005).

The ongoing work by Vagasky et al. (2024) and others that map the distribution, including the frequency and intensity of lightning events impacting the ground, could be used for informing interventions and ascertaining if the hazard is intensifying across the entire US or within certain regions of the US. Overlaying these maps with population demographics could also inform educational campaigns aimed at preventing lightning-related injuries and deaths. Continued vigilance and active reporting of lightning hazards by the media and government sources remains warranted to prevent complacency from the public health successes related to lightning over the last several decades, all while the incidence and intensity of lightning has likely been increasing in growing US population centers.

Competing Interests

Dr. Marion and Eli Lanning have no relevant financial interests. Dr. Marion is the owner of Eastern Scientific, LLC, which focuses on water quality. Dr. Marion is also the inventor of a water quality testing product for fecal contamination. Dr. Brown has received travel support for speaking engagements within the past three years while serving as the President and Past-President of the National Environmental Health Association. Dr. Brown is President of JHB Environmental/Occupational Health Consultants, LLC which performs industrial hygiene and safety-related consulting and training services for industry, government, non-profit, and educational entities. Non-financial interests: Dr. Gary Brown has served on the Board of Directors for the National Environmental Health Association.

Funding

This work was supported, in part, by the National Institute for Occupational Safety and Health through an Occupational Safety and Health Education Research Center T42 award to the Central Appalachian Regional Education and Research Center (No. 5T42OH010278-12, PI: W.T. Sanderson, University of Kentucky). Drs. Jason Marion and D. Gary Brown received support from the T42 award as the Co-Director and Director of the Industrial Hygiene Core affiliated with the Center award, respectively. Eli Lanning received trainingship support for graduate-level education and research from the T42 award.

Author Contributions

All authors contributed to the study conception and design. A literature review was performed by Eli Lanning and reviewed by D. Gary Brown and Jason Marion. Data collection was performed by Eli Lanning and Jason Marion. Data analysis was performed by Jason Marion. The first draft of the manuscript was written by Jason Marion and Eli Lanning. All authors commented and reviewed previous versions of the manuscript. All authors read and approved the final manuscript.

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Assessment of Lightning Mortality in the United States from 1979 – 2022

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Abstract

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1 Introduction

2 Methodology

3 Results

4 Discussion and Conclusions

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Competing Interests

Funding

Author Contributions

References

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