Abstract C016: Evaluating the impact of major events on colorectal cancer incidence in Puerto Rico: An interrupted time-series analysis
Authors: Verganza Samantha , Torres-Cintrón Carlos R. , Gierbolini-Bermúdez Axel , Suárez-Ramos Tonatiuh , Tortolero-Luna Guillermo , Ortiz-Ortiz Karen J. 
Published: December 2023

Abstract
Background: In recent years, Puerto Rico (PR) has faced unprecedented events, disrupting the health system. In September 2017, a Category 5 Hurricane Maria hit PR just two weeks after Hurricane Irma, resulting in severe damage to healthcare facilities and infrastructure. Subsequently, in March 2020, the COVID-19 pandemic emerged, further interrupting healthcare services. Cancer patients handled numerous challenges during and after these major events. Also, the patterns of cancer in PR reflect underlying risk factors, disparities in healthcare access, and overall infrastructure limitations. Despite being highly preventable, colorectal cancer (CRC) remains one of the most incident and deadliest types of cancer in PR. This study aims to evaluate the impact of Hurricanes Irma and Maria, as well as the lockdown measures imposed during the COVID-19 pandemic on the incidence of CRC in PR. Methods: The source of information for this study was the Puerto Rico Central Cancer Registry (PRCCR) database. An interrupted time-series analysis (ITSA) design was used to compare monthly CRC diagnoses during the following four periods: 1) before the interruption of hurricanes Irma and Maria (January 2015 to August 2017), 2) during hurricanes and post hurricanes recovery (September 2017 to March 2018), 3) before the interruption of the COVID-19 pandemic (April 2018 to March 2020), and 4) during the pandemic restrictions (April 2020 to December 2020). We used ordinary least squares regression models with Newey-West standard errors to adjust for autocorrelation., In addition, The Cumby-Huizinga general test was used to assess for possible autocorrelation. Results: CRC monthly percent change (MPC) remained steady during the first period (95% CI= -0.006, 0.005, p-value=0.730). In the interruption of the hurricanes (September 2017), there appeared to be a significant decrease of 52.29% CRC cases (95% CI= -0.690, -0.356, p-value&lt;0.001), followed by a significant increase in the second period of a MPC of 10.71. Regarding the third period, the MPC declined by 11.38 (95% CI= -0.164, -0.064, p-value&lt;0.001). In the interruption of the COVID-19 pandemic (April 2020), a decrease of 34.94% cases was observed (95% CI= -0.891, 0.193, p-value=0.202), followed by an increase in the MPC of 6.37 during the fourth period. Conclusion: This study provides a first time description of the impact of two major interruptions in the PR health system infrastructure, specifically on CRC diagnoses. Our analyses confirm a change in level and trend caused by the hurricane's aftermath and the COVID-19 restrictions. More research is needed to better understand the potential factors associated with the decrease of the CRC MPC after post-hurricane recovery (third period), such as migration and changes in health system capacity.
Citation Format: Samantha Verganza, Carlos R. Torres-Cintrón, Axel Gierbolini-Bermúdez, Tonatiuh Suárez-Ramos, Guillermo Tortolero-Luna, Karen J. Ortiz-Ortiz. Evaluating the impact of major events on colorectal cancer incidence in Puerto Rico: An interrupted time-series analysis [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C016.