Hospital Resource Deficits in Climate Vulnerable United States Counties: Insights from a National Survey

Background: The recently published Climate Vulnerability Index (CVI) gives us a comprehensive overview of the counties that are most vulnerable to the effects of climate change. Understanding the health care delivery characteristics in these vulnerable communities may help to anticipate and mitigate the negative impacts of climate change. In this setting, we sought to assess hospital characteristics in the most climate-vulnerable counties in the United States. Methods: We conducted a cross-sectional study using county-level data from the CVI [2017-2019] to stratify counties into quintiles of climate vulnerability. These data were linked with hospital characteristics from the American Hospital Association survey [2016] and population characteristics from the American Community Survey [2021]. We analyzed the hospital and demographic characteristics of the most climate vulnerable counties. Results: Hospitals in the most climate-vulnerable counties are significantly more likely to be located in rural areas (34% vs. 24%, P<0.001), smaller in bed size (mean 135 vs. 167 beds, P<0.001), more often classified as rural referral centers (7.2% vs. 4.0%, P<0.001) or sole community providers (11% vs. 6.9%, P<0.001), and more likely to be private equity-owned (6.2% vs. 3.8%, P<0.001). They employ fewer full-time personnel, including physicians (mean 110 vs. 336, P<0.001) and nurses (mean 187 vs. 267, P<0.001), and have reduced diagnostic capabilities, with lower availability of magnetic resonance imaging (75% vs. 79%, P=0.008) and advanced computed tomography scanners (52% vs. 64%, P<0.001). The populations in these counties have a higher proportion of non-Hispanic Black residents (24% vs. 10%, P<0.001), lower education levels (18% vs. 28% with bachelor's degree, P<0.001), a higher percentage of individuals with disabilities (18% vs. 14%, P<0.001), and significantly higher poverty rates (20% vs. 14%, P<0.001) compared to national averages. Conclusions: Our results indicate that hospitals in the most climate-vulnerable counties in the United States are smaller and less well-resourced, with fewer beds, intensive care units, and clinical staff. Targeted investments are needed to strengthen their infrastructure and capacity, ensuring they can effectively respond to climate-related emergencies and support health equity in the face of climate change.