Power outages can threaten the lives of medical device users – knowing who is most at risk will help cities respond

Many older adults rely on electric-powered medical equipment, such as portable oxygen and nebulizers that help them breathe. Westend61 via Getty Images When the power goes out and stays off for hours, the result can be more than just a hassle – for millions of Americans who rely on medical equipment, losing electricity can become a medical emergency. Your neighbor might rely on an oxygen concentrator to breathe – a machine the size of a carry-on bag that hums quietly through the night. Or they might need a CPAP – continuous positive airway pressure – machine to keep them breathing safely in their sleep, or a ventilator. Most home medical devices run on backup batteries that last only 3 to 8 hours. Yet people in over half of U.S. counties experienced at least one outage lasting more than eight hours between 2018 and 2021. Power outages are becoming more common in the U.S., too. They grew 9% more frequent and lasted 56% longer between 2014 and 2023, driven by severe weather, winter storms, hurricanes and wildfires linked to climate change. Studies following major blackouts show an increase in disease-related deaths, including a 25% rise during a three-day blackout in New York City in August 2003. Emergency rooms can become overwhelmed with device users seeking backup power and medical care. But not everyone with a medical device faces the same risks during a power outage. In a new study published in the journal Environmental Research: Health, we show which groups need the most help and who is slipping through the cracks in life-threatening ways.

Four very different realities We analyzed data from more than 2,600 households reporting the use of medical devices, drawn from a nationally representative federal survey of nearly 18,500 American homes. Using statistical modeling, we identified four distinct groups, each facing a very different situation when the power goes out. About 60% of medically dependent households are financially stable homeowners. They face outages, but they are the most likely group to have backup generators. A second group, roughly 20%, are homeowners who struggle to pay their energy bills and sometimes skip medicine or meals to keep the lights on, but who also tend to have backup power sources. This group had the highest likelihood of experiencing dayslong power outages in the past year, but was also more likely to have a generator or access to solar power than the average American. A third group is apartment renters who can afford their electricity bills but are typically unable to make long-term upgrades for more resilient power supplies. For example, they can’t install solar panels or add permanent backup power because those decisions belong to their landlord, not them.

The fourth class is the smallest, roughly 7% of medical device households, and by far the most at risk. These are mostly low-income urban renters, and they face two compounding problems: They struggle to pay their electricity bills every month, and they have almost no backup resources when the power goes out. Nearly 58% of these at-risk renters said they had received a disconnection notice from their utility within the previous year. One in eight had needed medical attention because their home got too hot or too cold. This group is also disproportionately Black or Hispanic. Our findings confirm what researchers have long suspected: Energy insecurity among medical device users is deeply tied to income, housing type and race. Our study also shows the importance of understanding where people are both energy insecure and less likely to have access to backup power sources during outages. What communities are doing today Some communities are finding ways to tackle pieces of this problem. Most utility companies maintain lists of households with medical devices, and they are supposed to notify customers ahead of power shutoffs and prioritize restoring power to their homes. However, studies show that these registries capture only a fraction of the people who qualify. If medical device users were instead automatically enrolled during a doctor’s visit, or if landlords were required to notify new tenants of these registries, those steps could help reach more people. Portable battery programs, like those run by California’s largest utilities, provide free or low-cost rechargeable batteries and a solar panel kit to homeowners and renters with medical devices who are most at risk of power shutoffs. Contractors can work with households to choose an appropriate battery to ensure it isn’t too heavy or difficult to transport if evacuating because of a wildfire or other disaster. As climate change makes blackouts longer and more frequent – and as federal low-income energy assistance programs face cuts – providing help to residents falls increasingly on states and cities. Knowing which households face the greatest risks can make it easier to target aid to those in need.

The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.