Background and aim Precipitated by an unusual winter storm, the 2021 Texas Power Crisis lasted from February 10 to 27. Such large-scale outages reflect aging electrical grids, underinvestment, and a changing climate. Power outages can have serious health consequences, especially among vulnerable subpopulations such as those reliant on electricity to power medical equipment, but limited studies have evaluated disparate exposures to outages. We used an environmental justice lens to characterize the distribution, duration, and disparities of the Texas Power Crisis. Methods We used hourly Texas-wide county-level power outage data to describe the association and geographic clustering between outage exposure (distribution and duration) and six variables: electricity-dependent durable medical equipment (DME) usage, the Centers for Disease Control and Prevention Social Vulnerability Index (SVI), Black and Hispanic populations, nursing homes, and hospitals. We supplemented these county-level analyses with an internet survey among Texas residents to further investigate issues of environmental justice related to outage experiences and preparedness. Results At the peak, nearly 1/3 of customers (N = 4,025,815) in the state lost power. County-level spatial analyses indicated racial/ethnic but not socioeconomic or medical disparities in power outage exposure. With individual survey data, we found less preparedness among younger individuals and those with lower educational attainment. Overall preparedness levels among Texans were low and were no higher among DME users (45% vs. 44%) – the group that likely faces the greatest health risks during outages. Conclusions Power outages coupled with extreme weather events can be deadly, and medically vulnerable, socioeconomically vulnerable, and marginalized groups may be disproportionately impacted. Climate and energy policy must consider these groups in planning and decision-making processes surrounding power outages including future grid improvements, and disaster preparedness and management Keywords power outage, durable medical equipment, Texas, climate change, extreme cold weather, environmental justice