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A study of Medicare beneficiaries in North Carolina found that more detailed measures of hurricane flooding showed stronger and more consistent associations with hospitalizations and deaths among adults 65 and older who used electricity-dependent medical devices. County-level disaster declarations showed no significant immediate changes after Hurricanes Matthew or Florence, while the study found sustained increases over the following year after Matthew. Black participants experienced worse short- and long-term outcomes as flooding severity increased.
A study of older adults in North Carolina who relied on electricity-dependent medical devices found that hurricane flooding was associated with higher hospitalizations and deaths, with worse outcomes for Black participants as flood severity increased. Published in the Journal of the American Geriatrics Society, the research analyzed Medicare beneficiaries aged 65 and older after Hurricanes Matthew and Florence.
The researchers examined the immediate and year-long effects of the two storms on hospitalizations and deaths among beneficiaries using equipment such as ventilators, respirators and dialysis machines. Using county-level Federal Emergency Management Agency disaster declarations, they found no significant immediate changes after either hurricane. They did find sustained increases in hospitalizations and deaths during the year after Hurricane Matthew.
A second analysis used the North Carolina Flood Extent Archive, which records flooding at a more detailed geographic scale than county-level disaster declarations. With this measure, the researchers found stronger and more consistent associations between hurricane exposure and the outcomes. The source report does not provide specific effect sizes, so the magnitude of those associations cannot be stated here.
The study also reported that Black individuals had worse short- and long-term outcomes as flooding severity rose. Its findings concern associations in the populations and storms studied; they do not establish that flooding alone caused an individual hospitalization or death. The paper, titled “Assessing the effects of hurricane hazards on hospitalization or death among older adults using electricity-dependent medical devices,” was published in 2026, with DOI 10.1111/jgs.70757.
Flood Exposure and Medical Vulnerability
People who depend on electricity-powered medical equipment can face risks when storms disrupt power, transport, access to care or household routines. The study’s findings suggest that assessing exposure through broad county disaster declarations may miss local variation in flooding and its relationship to health outcomes. More detailed flood data may help researchers and emergency planners identify where medically vulnerable residents could need additional support.
The reported differences by race also point to unequal outcomes as flooding worsened. The study does not explain the reasons for that pattern, but it makes the distribution of risk relevant to disaster planning. The findings may inform future work with communities and agencies; they do not by themselves establish which specific preparedness measures will reduce hospitalizations or deaths.
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Two North Carolina Hurricanes Studied
The analysis focused on Hurricane Matthew in 2016 and Hurricane Florence in 2018, and on Medicare beneficiaries aged 65 or older in North Carolina who used electricity-dependent medical equipment. Researchers compared health outcomes following the storms using two ways of describing hurricane exposure: FEMA county-level disaster declarations and the state’s higher-resolution flood archive.
The distinction between those measures matters to interpreting the results. The disaster-declaration analysis found no significant immediate change after either storm, but did find sustained increases over the year after Matthew. The more detailed flood-exposure analysis showed stronger and more consistent associations. Those findings are specific to the study population, locations and storms; the provided report does not establish whether the same patterns apply to other hurricanes or regions.
“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
Limits of the Reported Findings
The source summary does not give numerical effect estimates, confidence intervals, or detailed methods, so readers cannot assess the size and precision of the reported associations from that summary alone. It also does not explain what contributed to the worse outcomes among Black participants as flooding severity increased.
The findings do not establish that hurricane exposure caused each recorded outcome, nor do they show whether the same associations hold for other storms, states or age groups. The summary also does not specify which device users faced the greatest risks or whether particular disruptions—such as power loss or interrupted treatment—accounted for the patterns.
Broader Research and Preparedness Work
Senior author Jennifer L. Lund said the team’s work is intended to support broader study of hurricane and flood effects on medically vulnerable populations. She also described plans to partner with community organizations and local and state agencies on disaster preparedness and planning. The report does not announce a specific next study, timeline or policy change.
Further research would be needed to clarify why outcomes differed with flood severity, how risks vary among device users, and which preparedness steps could help. Until those details are available, this study offers evidence of associations in North Carolina after Matthew and Florence rather than a tested prescription for reducing harm.
Key Questions
Which storms did the study examine?
It examined outcomes after Hurricane Matthew in 2016 and Hurricane Florence in 2018 among older Medicare beneficiaries in North Carolina.
Who was included in the study?
The study focused on North Carolina Medicare beneficiaries aged 65 and older who used electricity-dependent medical equipment, including ventilators, respirators or dialysis machines.
Did the researchers find immediate increases after both hurricanes?
No significant immediate changes were found using county-level FEMA disaster declarations. The study did report sustained increases in hospitalizations and deaths over the year after Matthew.
What did the flood archive analysis add?
Using the higher-resolution North Carolina Flood Extent Archive, the researchers found stronger and more consistent associations between hurricane exposure and hospitalizations and deaths than in the county-level declaration analysis.
Does the study prove flooding caused the outcomes?
No. The report describes associations between exposure and outcomes, not proof that flooding caused a particular hospitalization or death. It also does not explain the reasons for the worse outcomes reported among Black participants as flooding severity increased.
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