(ASPOT40) Evaluating the intersection of climate vulnerability and cancer burden in North Carolina

Background: Climate-related extreme weather events (e.g., hurricanes) have been associated with interruptions to cancer care, impacting health outcomes across the cancer continuum. Further, the changing frequency and behavior of these events have made it increasingly difficult for communities to prepare and respond to these challenges. Extreme weather events disproportionately impact communities most vulnerable to the present and growing burden of climate change. Publicly available climate and cancer data can help identify geographic areas with overlapping climate vulnerability and cancer burden.

Objectives: Evaluate intersections between cancer burden and climate vulnerability by describing county-level cancer incidence and mortality rates according to aggregated county-level measures of climate vulnerability in NC.

Methods: We used the county-level baseline vulnerabilities and climate change risk data from the U.S. Climate Vulnerability Index (CVI) and the 2017-2021 county-level cancer incidence and mortality data reported by the North Carolina (NC) Department of Health and Human Services. Counties were ranked based on their CVI and cancer incidence and mortality rates per 100,000 people. Relations between county climate vulnerability and cancer burden were analyzed using Spearman’s rank (r) correlation.

Results: Across the 100 counties in NC, the age adjusted cancer-incidence ranged from 261 to 535 (median=471, IQR=442-493) and mortality ranged from 125 to 229 (median=162, IQR=151-173). A robust correlation was identified between CVI and cancer mortality (r=0.72), revealing communities more vulnerable to climate threats bear a disproportionate burden of cancer mortality. Scotland, Robeson, and Halifax counties had the highest overall CVI scores of 0.68, 0.67, and 0.66, with respective cancer mortality rates of 193, 195, and 196. Subgroup analysis by cancer site revealed the strongest correlations between CVI and cancer mortality from colon/rectum (r=0.61), lung (r=0.56), and breast (r=0.39), respectively. Conversely, incidence was only modestly correlated with CVI (r=0.22).

Conclusions: Research focused on the impacts of climate change on cancer outcomes has the potential to inform equitable climate preparation, mitigation, and adaptation strategies. Mapping cancer mortality rates to the climate hazards relevant for NC can help cancer centers and hospitals better prepare for the impacts of extreme weather events and direct public health resources to the people and places most likely affected.