Assessing the Effects of Hurricane Hazards on Hospitalization or Death Among Older Adults Using Electricity‐Dependent Medical Devices
Bradford E. Jackson, Arrianna Marie Planey, Helena M. Garcia, Shabbar Ranapurwala, Christopher D. Baggett, Jillian Evans‐Strong, Amy Lowman, Paul Delamater, Eboneé Nicole Butler, John Wallace, Jennifer L. LundABSTRACT
Background
To evaluate short‐term effects of Hurricanes Matthew (2016) and Florence (2018) on hospitalization or death among older adults using electricity—dependent durable medical equipment (edDME) in North Carolina, and to assess how hurricane exposure definitions influence associations.
Methods
We conducted controlled interrupted time series analyses using NC Medicare data (2015–2019). Monthly cohorts of beneficiaries aged ≥ 65 years with recent edDME use were classified as hurricane‐exposed or unexposed using FEMA county‐level disaster declarations. Exploratory analyses applied North Carolina Flood Extent Archive (FLDEX) to define exposure by residential flooding thresholds. The primary outcome was 30‐day all cause hospitalization or death. ARIMA models estimated immediate level changes and sustained trends, including race‐stratified analysis.
Results
Using FEMA definitions, we observed no significant immediate changes following either hurricane, but a sustained increase in hospitalization or death after Hurricane Matthew. FLDEX‐based analyses showed stronger and more consistent exposure‐outcome associations, particularly at higher flooding thresholds and among Black beneficiaries.
Conclusions
Coarse FEMA disaster designations may obscure important dose‐dependent and racially patterned health effects of hurricanes. Higher‐resolution exposure metrics may improve disaster surveillance and targeting of preparedness resources for medically vulnerable populations.