ASPO Abstracts
Did exposure to Hurricane Andrew (1992) influence survival among people diagnosed with cancer? A 20-year retrospective survival study of people diagnosed with cancer in South Florida.
Category: Cancer Health Disparities
Conference Year: 2023
Abstract Body:
Purpose: Limited research has examined the extent to which extreme weather events, which are expected to increase in frequency and severity due to climate change, disrupt cancer care. The purpose of this study was to examine whether exposure to Hurricane Andrew, a Category 5 storm, influenced survival among people diagnosed with breast, gynecological, and colorectal cancer in South Florida prior to the storm and whether the effect varied by race/ethnicity. Methods: We used the Florida Cancer Data System registry to identify adults in Florida diagnosed with breast, gynecological, and colorectal cancer in the six months prior to when Hurricane Andrew made landfall in Miami-Dade County (MDC). Cases in MDC were coded as disaster-exposed and compared to matched cases selected from Florida counties that sustained hurricane-related winds and storm surge (disaster-proximal) and Florida counties that did not experience a hurricane during the study period (unexposed). Kaplan-Meier curves were fit to estimate probability of survival and groups were compared using the log-rank test. Associations between hurricane exposure and survival were examined using crude and adjusted Cox proportional hazards models. Results: We identified 1,199 cancer cases diagnosed among Non-Hispanic White, Non-Hispanic Black, and Hispanic/Latino people in MDC in the sixth months prior to when Hurricane Andrew made landfall. The disaster-exposed group had poorer median survival [97.1 months] than the disaster-proximal [102.4 months] and unexposed [116.2 months] groups (P<.05). Disaster-exposed people had worse overall survival than unexposed people in both crude (hazard ratio [HR], 1.16 [95% CI, 1.06-1.28]; P<.01) and adjusted (HR, 1.23 [95% CI, 1.10-1.37]; P<.001) analyses. These effects varied significantly when analyzed by race/ethnicity and cancer type. Conclusions: These data suggest that hurricane exposure decreases probability of survival among people diagnosed with cancer and that the effect varies by race/ethnicity. Future studies investigating the role of exposure to natural disasters in patterning disparities in cancer outcomes, stratified by social and neighborhood context, may advance our understanding of who is most affected by these phenomena for different cancers.
Keywords: climate change; cancer; survival; cancer disparities; social determinants of health