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A study of Medicare beneficiaries aged 65 and older in North Carolina found that hurricane-related flooding was associated with increased hospitalizations and deaths among people using electricity-dependent medical devices. County disaster declarations showed no significant immediate changes after Hurricanes Matthew and Florence, while more detailed flood data showed stronger associations and worse outcomes for Black individuals as flooding severity rose.
A study of North Carolina Medicare beneficiaries aged 65 and older who used electricity-dependent medical devices found that hurricane exposure—especially flooding measured with detailed local data—was associated with higher hospitalizations and deaths. The research, published in the Journal of the American Geriatrics Society, found no significant immediate changes when exposure was classified using county disaster declarations, but identified sustained increases after Hurricane Matthew and stronger, more consistent associations using flood extent data.
Researchers assessed health outcomes during the year following Hurricanes Matthew in 2016 and Florence in 2018. The study population consisted of Medicare beneficiaries in North Carolina aged 65 or older who used electricity-dependent equipment, including ventilators, respirators and dialysis machines. The investigators compared hurricane hazards with hospitalizations and deaths.
When the team used county-level Federal Emergency Management Agency disaster declarations to classify exposure, it found no significant immediate changes after either storm. The researchers did, however, observe sustained increases in hospitalizations and deaths over the year following Matthew. Analyses using the North Carolina Flood Extent Archive, which provides more geographically detailed information about flooding, showed stronger and more consistent associations between exposure and those outcomes.
The report also found that Black individuals experienced worse short- and long-term outcomes as flooding severity increased. The supplied study summary does not give the size of the changes, the number of people affected or a specific explanation for the racial differences. The findings describe associations; they do not establish that flooding alone caused each hospitalization or death.
Flood Exposure and Patient Risk
People who depend on powered medical equipment can face particular challenges when a hurricane disrupts electricity, transport or access to health services. The study links flood exposure with adverse outcomes in an older population reliant on such devices, adding evidence that risks may continue beyond a storm’s immediate passage. Its findings make local flood conditions, not just county-level disaster status, relevant to understanding which patients may be at risk.
The reported differences by race also point to the importance of examining how disaster impacts vary across communities. The study does not identify the reasons for those differences, but its results can help guide further research and inform discussions about preparedness for medically vulnerable residents. The authors say the work is intended to support collaboration with community groups and public agencies on disaster planning.
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Two North Carolina Hurricanes Studied
The researchers focused on Matthew and Florence, storms that affected North Carolina in 2016 and 2018. Rather than studying all residents, they examined older Medicare beneficiaries identified as using electricity-dependent medical equipment and tracked hospitalizations and deaths after the hurricanes.
The study compared two ways of representing hurricane exposure: county-level presidential disaster declarations and the state’s Flood Extent Archive. The different patterns across those approaches matter when interpreting the results. A broad county declaration may not capture how severely particular neighborhoods flooded, while the archive allowed the team to assess exposure at a more detailed geographic level. The paper is titled “Assessing the effects of hurricane hazards on hospitalization or death among older adults using electricity-dependent medical devices” and was published in 2026.
“Over the past two years, our team has linked hurricane hazard and health care utilization data in North Carolina while working with impacted communities to shape this research.”
— Jennifer L. Lund, senior author and researcher at the UNC Gillings School of Global Public Health
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Limits of the Reported Findings
The available study summary does not provide effect sizes, confidence intervals, participant counts or detailed results for each storm. It also does not specify which individual device users experienced the recorded outcomes, or how outages, evacuation, health-care access and other factors contributed. Those details would be needed to judge the magnitude and pathways of the associations.
The findings are based on two hurricanes in one state and on Medicare beneficiaries aged 65 and older who used the identified equipment. It is not clear from the summary how well the results apply to younger people, residents elsewhere or patients using other forms of medical technology. The reported differences by race are associations with increasing flood severity; the summary does not establish their causes.
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Further Research and Preparedness
The researchers say the work provides a basis for examining hurricane and flood effects on medically vulnerable populations more broadly. Lund also described plans to partner with community organizations and local and state agencies on disaster preparedness and planning. The supplied report does not announce a specific follow-up study, agency action or timetable.
Further studies could clarify how the severity and location of flooding relate to outcomes, what factors explain differences between communities, and which preparedness measures may reduce risks. Until those results are available, the current evidence supports a focused conclusion: detailed flood exposure was associated with worse health outcomes in this study population, but the report does not establish a single cause or quantify the risk for individual patients.
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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 medical equipment.
Which hurricanes did researchers examine?
The study assessed outcomes during the year after Hurricane Matthew in 2016 and Hurricane Florence in 2018.
What did the study find about flooding?
Analyses using the North Carolina Flood Extent Archive showed stronger and more consistent associations between hurricane exposure and hospitalization or death than analyses based on county disaster declarations. The summary does not provide risk estimates or show that flooding alone caused the outcomes.
Did the study find differences by race?
Yes. The report says Black individuals experienced worse short- and long-term outcomes as flooding severity increased. It does not specify the reasons for the differences.
What remains unknown?
The available summary does not include the size of the observed changes, participant counts or a detailed account of factors such as power loss and access to care. It also does not identify a specific follow-up study or public-agency action.
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