Trends from 2008-2018 in electricity-dependent durable medical equipment rentals and sociodemographic disparities.

BACKGROUND Duration and number of power outages have increased over time, partly fueled by climate change, putting users of electricity-dependent durable medical equipment (hereafter, "durable medical equipment") at particular risk of adverse health outcomes. Given health disparities in the United States, we assessed trends in durable medical equipment rental prevalence and individual- and area-level sociodemographic inequalities. METHODS Using Kaiser Permanente South California (KPSC) electronic health record data, we identified durable medical equipment renters. We calculated annual prevalence of equipment rental and fit hierarchical generalized linear models with ZIP code random intercepts, stratified by rental of breast pumps or other equipment. RESULTS 243,559 KPSC members rented durable medical equipment between 2008-2018. Rental prevalence increased over time across age, sex, racial-ethnic, and Medicaid categories, most by >100%. In adjusted analyses, Medicaid use was associated with increased prevalence and 108 (95% CI: 99, 117) additional days of equipment rental during the study period. ZIP code-level sociodemographics were associated with increased prevalence of equipment rentals, for example, a one standard-deviation increase in percent unemployed and < high school diploma (prevalence ratio [PR] = 1.1, 95% CI: 1.1, 1.1; and PR = 1.1, 95% CI: 1.1, 1.2, respectively). Increased Supplemental Nutrition Assistance Program usage was associated with decreased breast pump rentals (PR = 0.83, 95% CI: 0.78, 0.88). CONCLUSIONS We observed some socioeconomic disparities among a growing electricity-dependent population. Our findings are consistent with the hypothesis that reliable electricity access is increasingly required to meet the health needs of medically disadvantaged groups.