(ASPOT34) Climate vulnerability and utilization of electricity-dependent durable medical equipment among Medicare beneficiaries in North Carolina

Background: Climate change-exacerbated extreme weather events have resulted in historic failures of power infrastructure and prolonged power outages in the United States (US). As such, there is substantial concern for the health of the more than 4.5 million Medicare beneficiaries who rely on electricity-dependent durable medical equipment (DME) and assistive devices. It is unknown how climate vulnerability may impact the health of individuals who rely on electricity-dependent DME.

Objectives: To describe the overlapping burden of climate and medical vulnerability, defined by electricity-dependent DME utilization, across counties in North Carolina (NC), US.

Methods: We assessed county-level susceptibility to climate disasters in NC using the US Climate Vulnerability Index (CVI) – a composite score that includes environmental, public health, socioeconomic, and neighborhood infrastructure metrics collected between 2003-2022. For each county-year, we quantified per capita count of Medicare beneficiaries who utilized electricity-dependent DME , using 2016-2022 data from the US Health and Human Services emPOWER initiative. Electricity dependent DME use was defined by evidence of a recent Medicare claim for one or more of the following: ventilator, IV infusion and suction pump, mobility device, electric bed, at-home dialysis, or cardiac device. Counties were ranked by highest and lowest CVI and electricity-dependent DME usage per 100 Medicare beneficiaries. Relationships were assessed using Spearman rank correlation coefficients.

Results: In 2022, across NC’s 100 counties, DME use ranged from 3 to 9 per 100 beneficiaries (mean=5.5, std=1.3). CVI was highest in counties with the lowest baseline health, socioeconomic, and infrastructure indicators (r=0.94, 0.87, 0.84, respectively). The most vulnerable counties were Scotland, Robeson, and Halifax, where corresponding electricity-dependent DME use was 4.9, 5.7, and 5.1 per 100 beneficiaries. CVI was lowest in Wake, Dare, and Orange counties, where 3.4, 3.4, and 2.9 per 100 beneficiaries utilized electricity-dependent DME, respectively. Counties ranking in the highest and lowest for DME use and CVI were largely consistent in years 2016-202 2. At the county level, higher CVI was correlated with higher proportions of annual per capita electricity-dependent DME use between 2016-2022 (r=0.19-0.33).

Conclusions: Counties with high climate vulnerability and high electricity-dependent DME utilization should be prioritized for resources at the state and federal levels to mitigate the sequelae of climate-fueled disasters. This study can inform emergency preparedness plans aimed at mitigating the impacts of extreme weather events on at-risk populations living in areas of high vulnerability.