The Effect of Exposure to Disaster on Cancer Survival
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University of Michigan School of Nursing , Ann Arbor , MI , USA; 2Institute for Healthcare Policy and Innovation, University of Michigan , Ann Arbor , MI , USA; 3Department of Biostatistics, University of Michigan School of Public Health , Ann Arbor , MI , USA; 4Department of Internal Medicine, University of Michigan Medical School , Ann Arbor , MI , USA; 5University of Michigan Institute for Social Research , Ann Arbor , MI , USA.
J Gen Intern Med DOI: 10.1007/s11606-019-05465-x © Society of General Internal Medicine 2019
INTRODUCTION
The frequency and intensity of weather and climate-related disasters that have devastating effects on millions of Americans is expected to increase due to climate change.1, 2 While the direct death toll of disasters is well-recognized,3 little is known regarding how the impact of disasters and their resultant disruption on healthcare affect health outcomes among individuals with serious health conditions and complex healthcare needs. We examined 10-year survival among a large sample of cancer patients diagnosed in areas affected by Hurricane Katrina in 2005.
METHODS
We used the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) registry to examine the relationship between exposure to Hurricane Katrina and 10-year survival. We identified adults diagnosed with invasive breast, colorectal, and lung cancer who received a diagnosis in the six months before Hurricane Katrina’s landfall in the fifteen most affected Louisiana parishes. These common cancers were chosen because they require coordinated, multispecialty treatment. The disaster-exposed group was compared to cases matched 1:4 on diagnosis, year of diagnosis, and socioeconomic status (measured as county-level median income) in 164 counties across 9 SEER registries outside of Louisiana which had not experienced a hurricane or tropical storm during the study period. Using Federal Emergency Management Administration disaster declaration data,2 patients were excluded from the comparison group if they resided in areas affected by any other hurricane or tropical storm during the study period. Covariates in our models were cancer stage, age of diagnosis, sex, race/ethnicity, and marital status. The Kaplan-Meier method was used to estimate survival by exposure status, and the exposed versus non-exposed groups were compared using the log-rank test. Cox
proportional hazards models were used to examine the association between exposure status and adjust for sociodemographic characteristics and cancer stage. This study was declared exempt from ethical approval as data are publicly available (see data availability statement).
RESULTS
We identified 1,738 cancer cases diagnosed (794 breast, 532 colorectal, and 412 lung) in parishes affected by Hurricane Katrina and a matched sample of 6557 cancer cases. In unadjusted analyses, exposure to Hurricane Katrina was associated with a 15% increase in mortality among adults with breast and lung cancer (HR = 1.15, p value < 0.05 for both) (Fig. 1). With further adjustmen
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