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A study published in the Journal of the American Geriatrics Society examined older Medicare beneficiaries in North Carolina who used electricity-dependent medical devices during Hurricanes Matthew and Florence. County-level disaster declarations showed no significant immediate changes, while more detailed flood data linked greater exposure to worse health outcomes, with Black patients experiencing worse short- and long-term outcomes as flooding severity increased.
A study published in the Journal of the American Geriatrics Society found that older North Carolina Medicare beneficiaries who relied on electricity-dependent medical devices experienced worse health outcomes as hurricane-related flooding became more severe. The research examined hospitalizations and deaths following Hurricanes Matthew and Florence, highlighting potential risks for people whose medical care depends on powered equipment during disasters.
Researchers studied Medicare beneficiaries aged 65 and older in North Carolina who used equipment such as ventilators, respirators and dialysis machines. They assessed immediate effects as well as outcomes over the year after Hurricane Matthew in 2016 and Hurricane Florence in 2018.
When exposure was measured using county-level Federal Emergency Management Agency presidential disaster declarations, the team found no significant immediate changes after either storm. That analysis did find sustained increases in hospitalizations and deaths over the year after Matthew. The source report does not provide the size of those increases.
Using the higher-resolution North Carolina Flood Extent Archive produced stronger and more consistent associations between hurricane exposure and hospitalizations and deaths. The researchers also reported that Black individuals experienced worse short- and long-term outcomes as flooding severity increased. These are associations in the study; the available report does not establish that flooding alone caused the outcomes.
Flood Exposure and Patient Risk
The findings point to a particular vulnerability during hurricanes: older adults who depend on powered medical equipment may face health risks when flooding disrupts access to care or the conditions needed to use that equipment. The study does not specify which disruptions drove the observed outcomes, but its results make flood severity and local exposure relevant considerations for disaster preparedness.
The reported differences by race also matter for planning. Black participants had worse outcomes as flood severity increased, according to the study. The report does not identify the reasons for that disparity, so it cannot establish whether differences in infrastructure, resources, health status or other factors explain it. Still, the result supports examining how disaster risks and response resources are distributed across communities.
For health systems and emergency planners, the research offers evidence that broad county disaster labels may not capture the same patterns as detailed flood measurements. Identifying medically vulnerable residents and planning for continuity of electricity-dependent care could be important areas for further work, although this study did not test any particular intervention.
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Two North Carolina Hurricanes Studied
The analysis focused on two storms with different years of occurrence: Matthew in 2016 and Florence in 2018. The team tracked hospitalizations and deaths among older adults using electricity-dependent equipment over the following year, allowing it to examine both immediate and sustained outcomes.
The study compared two ways of characterizing exposure. FEMA presidential disaster declarations supplied a county-level measure, while the North Carolina Flood Extent Archive offered more detailed information about flooding. The stronger, more consistent associations in the flood-archive analyses suggest that the choice and resolution of exposure data can affect what patterns researchers detect.
The findings were published in the Journal of the American Geriatrics Society in 2026 under the title “Assessing the effects of hurricane hazards on hospitalization or death among older adults using electricity-dependent medical devices.” The report describes the work as part of a broader effort to connect hurricane hazard information with health care use in North Carolina.
“This work lays the foundation for studying how hurricanes and floods affect medically vulnerable populations more broadly—and for partnering with community organizations and local and state agencies to strengthen disaster preparedness and planning.”
— Jennifer L. Lund, senior author and researcher at the UNC Gillings School of Global Public Health
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Limits of the Available Findings
The report provides no numerical estimates for the increases or associations, so their magnitude cannot be assessed from the available details. It also does not describe the specific mechanisms connecting flooding with hospitalizations or deaths, or explain the reasons for the reported racial differences.
The study covered two hurricanes in one state and a defined group of older adults with Medicare coverage who used electricity-dependent devices. The reported findings may not apply in the same way to younger people, other regions, other disasters or patients using different kinds of medical support. The results describe associations, not proof that hurricane exposure caused each outcome.
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Broader Preparedness Research Ahead
The researchers said the work provides a basis for studying hurricane and flood effects among medically vulnerable populations more broadly. Lund also pointed to plans for partnership with community organizations and local and state agencies to strengthen disaster preparedness and planning.
The report does not give a schedule for follow-up studies or name a specific policy change. Further research would need to clarify the size of the observed risks, the pathways behind them and which preparedness measures could help protect people dependent on powered medical equipment.
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Key Questions
Who was included in the study?
The researchers examined North Carolina Medicare beneficiaries aged 65 and older who used electricity-dependent equipment, including ventilators, respirators or dialysis machines.
Which hurricanes did the researchers examine?
The study assessed outcomes after Hurricane Matthew in 2016 and Hurricane Florence in 2018, including the year following each storm.
What did the study find about immediate effects?
Using county-level FEMA disaster declarations, the researchers found no significant immediate changes after either hurricane. They reported sustained increases in hospitalizations and deaths over the year after Matthew.
Did the study show that flooding caused deaths or hospitalizations?
No. The report describes associations between flood exposure and health outcomes; it does not establish that flooding caused them. The available summary also does not identify the specific pathways involved.
What happens next?
The researchers described the study as groundwork for broader research and collaboration with community groups and government agencies. The report does not specify a timeline or announce a particular preparedness program.
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