Abstract
IMPORTANCE: Extreme weather events disproportionately affect vulnerable populations, particularly nursing home residents. In February 2021, Winter Storm Uri caused unprecedented power outages and water shortages across Texas. However, its impact on nursing home residents remains poorly understood. OBJECTIVE: To assess the association of power outages and water shortages during Winter Storm Uri with mortality and health care utilization among long-stay nursing home residents in Texas. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of long-stay nursing home residents before and after Winter Storm Uri (February 14 to February 17, 2021) in Texas. Data analysis was conducted from March 2024 to January 2025. EXPOSURE: Residing in a nursing home that experienced a power outage or water shortage during Winter Storm Uri. MAIN OUTCOMES AND MEASURES: The outcome measures were weekly rates of mortality, clinician visits to nursing homes, emergency department (ED) visits, and hospitalizations among long-stay nursing home residents. Medicare claims were used to determine weekly mortality, clinician visits, ED visits, and hospitalizations 6 weeks before and 6 weeks after the storm. Differences-in-differences (DiD) analysis using 2-level logistic regression models estimated changes in outcomes associated with nursing home power or water loss. RESULTS: Of 1174 nursing homes, 231 (19.7%) reported power or water outages. The sample included 45 439 long-stay residents, with 8521 in facilities with outages (mean [SD] age, 80.07 [12.21] years; 5664 female [66.47%]) and 36 918 in facilities without outages (mean [SD] age, 80.42 [11.92] years; 12 705 female [65.59%]). DiD analysis found that residents of nursing homes with outages had a 0.13% (95% CI, 0.03% to 0.23%) higher mortality rate in the 3 to 5 weeks after the storm than those without outages. There were no significant differences in clinician visits (DiD, -0.31%; 95% CI, -1.08% to 0.47%), ED visits (DiD, 0.11%; 95% CI, -0.12% to 0.34%), or hospitalizations (DiD, 0.07%; 95% CI, -0.10% to 0.23%). CONCLUSIONS AND RELEVANCE: In this cohort study of nursing home residents in Texas, power and water outages during Winter Storm Uri were associated with increased mortality but not ED visits or hospitalizations, highlighting the vulnerability of nursing home residents during extreme weather events.