Association of Natural Disasters on Trends of County-Level Prostate-Specific Antigen (PSA) Screening

Natural disasters may worsen cancer outcomes through treatment delays, screening interruptions, or fragmented health care delivery. We investigated whether climate-related natural disasters were associated with changes in county-level prostate-specific antigen (PSA) screening.

We modeled county-level screening estimates from the Behavioral Risk Factor Surveillance System (BRFSS) from 2004 to 2012 using Census-derived demographic weights. The Federal Emergency Management Agency (FEMA)'s Disaster Declarations Summaries database was used to include counties that experienced a single climate-related natural disaster. The year of disaster was considered the index date, with 2-year pre- and post-disaster periods used to model counterfactual screening prevalence with vs without a natural disaster. Primary outcome was county-level PSA screening prevalence. We applied log-linear regression to estimate prevalence ratios for the association between natural disaster and two-year county-level PSA screening.

In 37 states, 365 counties experienced a single natural disaster, including a total population of 7,584,059 men aged 40-79. Compared to baseline county-level screening prevalence, PSA screening in the 2-year post-disaster period was 8% lower (rate ratio [RR]:0.92, 95% CI: 0.90-0.94, P <0.001]).

We observed significantly lower county-level PSA screening prevalence following a climate-related natural disaster. These results underscore the potential impacts of climate-related natural disasters on cancer screening services.