Abstract PO-073: Using spatial analysis to identify environmental stressors that affected women with gynecological cancer in Puerto Rico during and after Hurricane María
Authors: Elías Camila V. , Méndez Pablo A , Martínez Liz M. , Ortiz Ana P. 
Published: January 2022

Abstract
Socially vulnerable communities, such as women, cancer patients, and minorities, are at a high risk of poor health outcomes after a disaster. This ongoing study analyzes specific environmental stressors that affected women with gynecological (gyn) cancer during and after Hurricane María (HM) in Puerto Rico (PR) in September 2017. To do this, we recruited and interviewed 271 women aged ≥ 21 years diagnosed with gyn cancer between Sept 2016 and Sept 2018, from which only 195 met all the selection criteria. Some sections in the interview were divided into two different time periods: 3 months before and 3 months after HM. To carry-out a geospatial analysis, physical addresses 3 months before and after HM were geocoded using ArcGIS World Geocoding Service, in ArcMap 10.8.1. The software provided “automatically matched addresses” and “matched addresses with tied candidates”. The addresses identified as “matched addresses with tied candidates” were verified during the rematch process while also confirmed with Google Earth. Environmental hazards information and risk exposure were based on existing Earth Observation Data and Geodatabases from multiple agencies: flood from the Federal Emergency Management Agency (FEMA), HM's eye track from the National Oceanic and Atmospheric Administration (NOAA), social vulnerability index from the Centers for Disease Control and Prevention (CDC), and landslides from United States Geological Survey (USGS). 100 (51.3%) women were diagnosed with gyn cancer before HM, and 95 (48.7%) were diagnosed with gyn cancer after HM. Hazards such as floods and landslides were some of the primary environmental stressors experienced by the participants during and after HM. Geocoding process provided 247 (91%) automatically matched addresses and 24 (9%) tied addresses. Spatial analysis suggests that 12.3% of the participants were living in areas with the highest indices of social vulnerability. Some differences were identified for flood exposure. Geospatial analysis using FEMA-Flood Maps, suggests 18.5% of women were living in flood prone areas. Interview results suggested 54.4% gyn cancer patients suffered floods. Consistent with the characteristic of the storm, most of the participants (62.6%) were inside HM's eye track. 12.8% of the participants were living in areas that suffered landslides. Gyn cancer patients in this study suffered severe environmental stressors as a result of HM. Diminishing environmental health issues to cancer patients is key to support their access to care and quality of life. Oncology care approaches should be included on emergency plans for disasters, to guarantee access to care and health equity of cancer patients. Our preliminary findings and results are suggesting that FEMA-Flood Maps were underestimating flood risk in PR. Providing the most accurate geospatial information is essential for Risk Management. This information is crucial since it will allow citizens and communities to be better prepared and to take adaptation measures before the event. NCI Grants (R25CA240120 & R21CA239457-02)
Citation Format: Camila V. Elías, Pablo A Méndez, Liz M. Martínez, Ana P. Ortiz. Using spatial analysis to identify environmental stressors that affected women with gynecological cancer in Puerto Rico during and after Hurricane María [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-073.