Abstract A010: Evaluating the aftermath of two major hurricanes and the COVID-19 pandemic on lung cancer Incidence in Puerto Rico: An interrupted time-series analysis
Authors: Suárez-Ramos Tonatiuh , Torres-Cintrón Carlos , Pagán-Santana Yisel 
Published: September 2024

Abstract
Background - In recent years, events like hurricanes and the COVID-19 pandemic have significantly impacted the daily lives and the healthcare system in Puerto Rico (PR). We aimed to evaluate the effect of these disruptions on lung cancer incidence. Methods - An interrupted time-series analysis (ITSA) was conducted to assess the impact of hurricanes and the COVID-19 pandemic on lung cancer incidence trends. To achieve this, the data was modeled using first-order autoregression through Prais-Winsten AR(1) regression. Monthly lung cancer cases from 2012 to 2021 were obtained from the PR Central Cancer Registry database. The analysis was divided into three periods: 1) pre-hurricanes (January 2012-August 2017), 2) post-hurricanes (September 2017-March 2020), and 3) onset of COVID-19 lockdown restrictions (April 2020-December 2021). Additionally, we measured the impact of the events by comparing the change in cases with the expected cases in the absence of the disruptions. Results - A steady trend was observed in monthly overall lung cancer cases during the pre-hurricane period. Immediately after the two major hurricanes, there was an immediate decrease of 10.2 cases, representing a 16.1% decline compared to the expected lung cancer cases. During the post-hurricanes period, lung cancer cases exhibited a significant upward trend, eventually surpassing the expected number. However, another decline in lung cancer cases was observed with the onset of the COVID-19 lockdown restrictions, representing a 22.9% decline compared to the expected cases. This decline was followed by a significant upward trend of 0.67 cases per month until the end of 2021, once again surpassing the expected number of cases. Similar patterns were observed by age group and for late-stage cases. However, early-stage lung cancer showed a higher percentage difference at the start of the COVID-19 lockdown restrictions compared to the other groups and did not surpass the expected number of cases by the end of the study. Conclusion - Our results demonstrate the impact of hurricanes and the COVID-19 lockdown on lung cancer incidence in PR. These disruptions led to limited access to healthcare, particularly diagnostic and screening services, as evidenced by the decrease in lung cancer cases. Although lung cancer cases gradually returned to the expected levels in the absence of disruptions, the long-term effects of delayed diagnoses due to these events should be closely monitored.
Citation Format: Tonatiuh Suárez-Ramos, Carlos Torres-Cintrón, Yisel Pagán-Santana. Evaluating the aftermath of two major hurricanes and the COVID-19 pandemic on lung cancer Incidence in Puerto Rico: An interrupted time-series analysis [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A010.