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A 2026 study examined hospitalizations and deaths among North Carolina Medicare beneficiaries aged 65 and older who relied on electricity-dependent medical equipment during Hurricanes Matthew and Florence. County-level disaster declarations showed no significant immediate changes after either storm, while analyses using detailed flood maps found stronger associations with worse outcomes, including poorer outcomes for Black participants as flood severity increased.
A study of North Carolina Medicare beneficiaries aged 65 and older who used electricity-dependent medical equipment found that hurricane-related flood exposure was associated with hospitalizations and deaths, with poorer short- and long-term outcomes for Black participants as flooding severity increased. Published in the Journal of the American Geriatrics Society, the research examined outcomes during the year after Hurricanes Matthew and Florence; the findings do not establish that flooding caused each outcome.
Researchers assessed people relying on equipment such as ventilators, respirators and dialysis machines, which depend on electricity to operate. They compared hospitalization and death outcomes after Hurricane Matthew in 2016 and Hurricane Florence in 2018. The population was limited to Medicare beneficiaries in North Carolina aged 65 or older who used electricity-dependent medical devices.
When the team measured exposure using county-level federal disaster declarations, it found no significant immediate changes after either hurricane. It did observe sustained increases in hospitalizations and deaths over the year after Matthew. The study summary does not report a comparable sustained increase for Florence using that county-level measure.
Analyses using the North Carolina Flood Extent Archive, a more detailed source of flood exposure information, showed stronger and more consistent associations between hurricane exposure and hospitalizations and deaths. The researchers also reported that Black participants experienced worse short- and long-term outcomes as flooding severity increased. The supplied summary provides no effect sizes or detailed breakdowns of individual outcomes, so the magnitude of these differences cannot be stated here.
Flood Exposure and Medical Dependence
For people whose care depends on powered medical equipment, storms and flooding can create risks that continue beyond the immediate emergency. A prolonged power interruption or disruption to healthcare access may matter to someone reliant on a ventilator or dialysis, although this study summary does not establish which specific pathways led to the observed outcomes.
The findings also point to the value of measuring flood exposure at a finer scale. County disaster declarations did not show the same consistent associations as detailed flood mapping, suggesting broad geographic classifications may miss differences in the flooding people experience. The reported worse outcomes for Black participants as flood severity rose highlight a disparity that preparedness planning and further research may need to address.
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How the Two Storms Were Studied
The research, by B. E. Jackson and colleagues, examined health outcomes following two North Carolina hurricanes: Matthew, in 2016, and Florence, in 2018. Rather than relying on a single measure of storm impact, investigators used both FEMA presidential disaster declarations by county and records from the North Carolina Flood Extent Archive.
That comparison matters to how the results should be read. A disaster declaration is a broad indicator tied to an area, while flood-extent data can describe exposure with greater geographic detail. The study’s stronger associations using the latter measure are findings about how the analysis changed with the exposure measure; they do not, on their own, prove a causal mechanism.
Senior author Jennifer L. Lund of the UNC Gillings School of Global Public Health said the team had spent two years linking hurricane hazard and healthcare-use data in North Carolina while working with communities affected by storms. The paper is titled “Assessing the Effects of Hurricane Hazards on Hospitalization or Death Among Older Adults Using Electricity-Dependent Medical Devices” and carries DOI 10.1111/jgs.70757.
“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, PhD, senior author and researcher at the UNC Gillings School of Global Public Health
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Limits of the Available Findings
The supplied study summary does not provide effect sizes, participant counts, confidence intervals or detailed results for each storm and outcome. It is not possible from that information to quantify how much risk changed or to compare the scale of the findings across the two hurricanes.
The results describe associations, not proof of causation. The summary also does not identify the precise reasons for the outcomes, such as power loss, interruptions in treatment, evacuation challenges or other storm-related conditions. Further, the research covered older Medicare beneficiaries in North Carolina who used electricity-dependent devices; it does not establish that the same pattern applies to all older adults, other states or other disasters.
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Research and Preparedness Ahead
Lund said the work is intended to support research into hurricane and flood effects on medically vulnerable populations beyond this group. The team also described plans to partner with community organizations and local and state agencies on disaster preparedness and planning. The source material does not give dates or specific policy changes that have been adopted.
Further studies could clarify how exposure, equipment dependence and health outcomes are connected, and whether the patterns differ by storm, flood severity or population group. Until more detail is available, the reported findings support attention to the needs of people dependent on powered care during disaster planning, but they do not provide individualized medical guidance.
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Key Questions
Who was included in the study?
The study examined North Carolina Medicare beneficiaries aged 65 and older who used electricity-dependent medical equipment.
Which hurricanes did researchers examine?
The researchers studied outcomes after Hurricane Matthew in 2016 and Hurricane Florence in 2018.
Did the study find immediate increases after both storms?
Using county-level federal disaster declarations, researchers found no significant immediate changes after either hurricane. They observed sustained increases in hospitalizations and deaths over the year after Matthew. More detailed flood mapping showed stronger and more consistent associations with outcomes.
Did the study prove that flooding caused the health outcomes?
No. The findings describe associations between hurricane or flood exposure and outcomes. The study summary does not establish that flooding directly caused individual hospitalizations or deaths.
What remains unknown about the findings?
The source summary does not give effect sizes, participant counts or detailed storm-by-storm results, and it does not identify the pathways behind the associations. The findings are limited to the population and storms studied.
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