Colorectal cancer diagnoses in Puerto Rico dropped significantly during and after Hurricanes Irma and Maria, and the COVID-19 pandemic, but later rebounded, revealing troubling concerns about the possible connection between natural disasters and CRC-detection rates.
An interrupted time series analysis published April 14 in Cancer found that these natural disasters created delayed access to screenings, leading to a surge in late-stage diagnoses. The study underscored needs to enhance healthcare infrastructure in disaster-prone regions.
The data analysis was conducted using monthly incidence data from the Puerto Rico Central Cancer Registry, a population-based registry that has achieved 95% case completeness since 2010, according to an April 14 report in the American Journal of Managed Care. The study focused on first-time CRC diagnoses among Puerto Rico residents from Jan. 1, 2023, to Dec. 31, 2021, identifying 18,537 cases for analysis. After excluding 448 cases without a known diagnosis month, the final cohort included 18,089 patients.
The analysis revealed a sharp and immediate decline in CRC diagnoses in Puerto Rico following Hurricanes Irma and Maria, and the onset of COVID-19 lockdown restrictions. There was an estimated drop of 8.3 cases, representing a 17.5% decrease from expected levels during the months of each disaster. By the end of the study period, the number of patients diagnosed with early-stage CRC and those within the recommended screening age group of 50 to 75 years old remained below expectations.
However, diagnoses among patients with late-stage disease, as well as those younger than 50 and older than 76, exceeded predicted levels, suggesting that these disasters created delayed care access that contributed to more advanced disease at diagnosis. While some limitations in data and possible emigration patterns may have affected the data, researchers overall said that this pointed to vital gaps in healthcare access in disaster-prone areas.
“These findings suggest that limited healthcare access during these events may have delayed cancer detection and may have worsened health outcomes,” said co-lead author Tonatiuh Suárez-Ramos, of the University of Puerto Rico Comprehensive Cancer Center, in a statement. “This issue is especially critical in Puerto Rico, since the healthcare system already faces important challenges.”
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