Evaluating the impact of hurricanes and the COVID-19 pandemic on colorectal cancer incidence in Puerto Rico: An interrupted time-series analysis

Background

Major events, such as Hurricanes Irma and Maria and the coronavirus disease 2019 (COVID-19) pandemic disrupted Puerto Rico's health system. Lack of access to colorectal cancer (CRC) screening services may have impeded timely diagnosis. The authors examined the impact of these events on CRC incidence in Puerto Rico.

Methods

The Puerto Rico Central Cancer Registry database allowed the authors to obtain CRC cases from 2012 to 2021. An interrupted time-series analysis was performed to examine changes in CRC incidence immediately after and during the periods after the hurricanes and the pandemic. Analysis periods included: pre-hurricanes, post-hurricanes, and post-COVID-19 lockdown restrictions.

Results

We observed a level change of −8.3 CRC cases was observed in the month the hurricanes struck Puerto Rico, corresponding to an immediate decrease of 17.5%. After a slight upward trend, a second decline of 39.4 CRC cases was estimated after the COVID-19 lockdown restrictions, representing an immediate change of −24.2%. By the end of the study, the estimated numbers of patients with early stage CRC patients and those aged 50–75 years did not reach the expected numbers. In addition, CRC cases in patients with late-stage disease and in those aged younger than 50 years and aged 76 years and older exceeded the expected numbers.

Conclusions

Hurricanes Irma and Maria and the COVID-19 pandemic caused a decrease in CRC incidence in Puerto Rico. This analysis suggests that limited access to CRC screening services during these events likely hindered CRC diagnoses. To fully understand the long-term effects, monitoring of CRC trends will be necessary in the coming years.