Hurricanes in the United States end up hundreds of times deadlier than the government calculates, contributing to more American deaths than car accidents or all the nation’s wars, a new study said.

The average storm hitting the U.S. contributes to the early deaths of 7,000 to 11,000 people over a 15-year period, which dwarfs the average of 24 immediate and direct deaths that the government counts in a hurricane’s aftermath, the study in Wednesday’s journal Nature concluded. Study authors said even with Hurricane Helene’s growing triple digit direct death count, many more people will die partly because of that storm in future years.

“Watching what’s happened here makes you think that this is going to be a decade of hardship on tap, not just what’s happening over the next couple of weeks,” said Stanford University climate economist Solomon Hsiang, a study co-author and a former White House science and technology official.

“After each storm there is sort of this surge of additional mortality in a state that’s been impacted that has not been previously documented or associated with hurricanes in any way,” Hsiang said.

Hsiang and University of California Berkeley researcher Rachel Young looked at hurricane deaths in a different way than previous studies, opting for a more long-term public health and economics-oriented analysis of what’s called excess mortality. They looked at states’ death rates after 501 different storms hitting the United States between 1930 and 2015. And what they found is that after each storm there’s a “bump” in death rates.

It’s a statistical signature that they see over and over, Hsiang said. Similar analyses are done for heat waves and other health threats like pollution and disease, he said. They compare to pre-storm times and adjust for other factors that could be causing changes in death rates, he said. Complicating everything is that the same places keep getting hit by multiple storms so there are death bumps upon death bumps.

Just how storms contribute to people’s deaths after the immediate impact is something that needs further study, Hsiang said. But he theorized it includes the health effects of stress, changes in the environment including toxins, people not being able to afford health care and other necessities because of storm costs, infrastructure damage and government changes in spending.

“When someone dies a few years after a hurricane hit them, the cause will be recorded as a heart attack, stroke or respiratory failure,” said Texas A&M University climate scientist Andrew Dessler, who wasn’t part of the study but has done similar studies on heat and cold deaths. “The doctor can’t possibly know that a hurricane contributed/triggered the illness. You can only see it in a statistical analysis like this.”