Puerto Rico (PR) has experienced multiple disasters in the last decade, including Hurricanes Irma and María (September 2017), a sequence of earthquakes (between December 2019 and January 2020), and the COVID-19 pandemic (starting in March 2020),1 all of which resulted in public health emergency declarations. In the aftermath of the hurricanes, PR residents experienced major disruptions in essential services for months, and the health care system was inoperable.1,2 The earthquakes led to island-wide power outages and school closings.1 Finally, on March 15, 2020, PR entered a COVID-19–related lockdown (executive order No. OE-2020-023) that continued until June 15, 2020 (executive order No. OE-2020-041). Quantifying cervical cancer screening disruptions is important in the context of rising cervical cancer incidence in PR.3 Therefore, we evaluated how the natural disasters and the pandemic factored into cervical cancer screening utilization in PR.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: August 9, 2021.
Published: October 15, 2021. doi:10.1001/jamanetworkopen.2021.28806
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Ortiz AP et al. JAMA Network Open.
Corresponding Author: Ana Patricia Ortiz, PhD, University of Puerto Rico Comprehensive Cancer Center, PO Box 363027, San Juan, PR 00936-3027 (email@example.com).
Author Contributions: Dr Ortiz-Ortiz and Mr Gierbolini-Bermúdez had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Ortiz, Ramos-Cartagena, Deshmukh.
Acquisition, analysis, or interpretation of data: Ortiz, Gierbolini-Bermúdez, Colón-López, Sonawane, Deshmukh, Ortiz-Ortiz.
Drafting of the manuscript: Ortiz, Ramos-Cartagena, Colón-López, Deshmukh.
Critical revision of the manuscript for important intellectual content: Ortiz, Gierbolini-Bermúdez, Ramos-Cartagena, Sonawane, Deshmukh, Ortiz-Ortiz.
Statistical analysis: Gierbolini-Bermúdez, Sonawane, Deshmukh, Ortiz-Ortiz.
Obtained funding: Ortiz, Colón-López, Deshmukh.
Administrative, technical, or material support: Ortiz, Colón-López, Deshmukh.
Supervision: Ortiz, Colón-López.
Conflict of Interest Disclosures: Dr Ortiz reported receiving grants from the National Institutes of Health during the conduct of the study, and reported consulting fees from Merck & Co outside the submitted work. Dr Ortiz-Ortiz reported receiving grants from the Centers for Disease Control and Prevention National Program of Cancer Registries and the National Cancer Institute during the conduct of the study, and reported grants from Abbvie Corp outside the submitted work. Dr Colón-López reported receiving consulting fees from Merck & Co outside the submitted work. Dr Ortiz-Ortiz reported receiving grants from Abbvie Corp and Merck & Co outside the submitted work. No other disclosures were reported.
Funding/Support: This study was supported by a National Cancer Institute U54 Grant (No. 2U54CA096297-18). The Puerto Rico Health Insurance Administration provided data for this study.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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