Identifying communities where older adults with major cancer diagnoses are contending with high levels of natural hazards.

Purpose: We aimed to identify geographical areas of vulnerability, namely co-occurring heightened cancer prevalence and exposure to natural hazards.

Methods: Cancer prevalence data for four major cancers (lung, breast, colorectal, and prostate) from the Centers for Medicare and Medicaid Services were used along with National Risk Index (NRI) for 18 hazards, including hurricane and wildfire, from the Federal Emergency Management Agency. We examined county-level spatial correlations between cancer prevalence and NRI values using Lee's L statistics.

Results: NRI values and cancer prevalence were positively correlated with substantial variations (global Lee's L = 0.24, p < 0.05; local Lee's L IQR -0.07 to 0.38). Out of 3106 counties in the contiguous United States, 455 (14.6%) had statistically significant spatial correlations between NRI values and cancer prevalence, of which 194 (43%) were hotspot counties with high NRI values correlated with high cancer prevalence. These hotspot counties were located mostly along coastlines, specifically the Atlantic and Gulf of Mexico with some pockets in the Midwest, primarily in urban areas (151, 77.8%), and within the catchment areas of National Cancer Institute-designated cancer centers (173, 89.2%). They also differed in the types of natural hazard and cancer, as well as community resilience and social vulnerability.

Conclusions: We identified several geographical areas in the United States with increased need, which may serve as priority areas for future research around the impacts of environmental exposures on cancer continuum. On a public health level, they also may guide prioritization efforts for environmental hazard planning and preparation.