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The extreme flooding in Western North Carolina caused by Tropical Storm Helene in September of 2024 is a recent and devastating example of this trend. Communities of color and low\u2010income populations are more likely to reside in flood\u2010prone areas due to structural factors, including residential racial segregation and economic inequality. As such, the adverse health and financial consequences of flood exposure overburden historically marginalized communities, which may have a more limited adaptive capacity to anticipate, respond to, and recover from flood events. Exposure to severe flooding further exacerbates chronic health conditions by impeding access to vital healthcare infrastructure and services. This study examines the spatial patterning of coastal and inland flood risk, neighborhood\u2010level structural determinants (i.e., racial and economic inequality), and flood\u2010sensitive health conditions in North Carolina using bivariate local indicators of spatial autocorrelation (LISA) statistics. High\u2010high clusters capture areas where neighborhoods with high racial or economic inequality surround elevated flood risks. These clusters are distinguished by select sociodemographic characteristics and concentrated in the eastern coastal and western mountainous regions of North Carolina. Cluster locations are priority areas for targeted resource allocation and interventions that strengthen the adaptive capacity of these communities in the context of climate change.<\/jats:p>","DOI":"10.1029\/2024gh001295","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T08:32:01Z","timestamp":1770021121000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Spatial Analysis of Flood Risk, Neighborhood Characteristics, and Chronic Health Conditions in North Carolina"],"prefix":"10.1029","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1303-9465","authenticated-orcid":false,"given":"S. E.","family":"Ulrich","sequence":"first","affiliation":[{"name":"Department of Geography and Planning Appalachian State University  Boone NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0315-4860","authenticated-orcid":false,"given":"M. M.","family":"Sugg","sequence":"additional","affiliation":[{"name":"Department of Geography and Planning Appalachian State University  Boone NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4967-3463","authenticated-orcid":false,"given":"S. M.","family":"Hatcher","sequence":"additional","affiliation":[{"name":"Occupational and Environmental Epidemiology Branch Division of Public Health North Carolina Department of Health and Human Services  Raleigh NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. D.","family":"Runkle","sequence":"additional","affiliation":[{"name":"North Carolina Institute for Climate Studies North Carolina State University  Asheville NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"13","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Aggarwal S. Hu J. K. Sullivan J. A. Parks R. M. &Nethery R. 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