Gaps in U.S. Public Health Monitoring and Surveillance Systems in Puerto Rico

Introduction: Puerto Rico (PR) has an ambiguous status within Centers for Disease Control and Prevention (CDC) public health monitoring and surveillance systems. However, as a U.S. territory, PR relies on federal health resource allocation processes that are informed by these data sources. This study sought to quantify the coverage of PR within CDC-supported systems compared with the 50 states, describe coverage across critical system-types, and assess the availability of data collection instruments in Spanish.

Methods: This cross-sectional observational study employed the method of data curation by identifying, collecting, and categorizing data primarily from web-based sources maintained by the CDC. Data were originally collected and coded from August 2021 to March 2022 and reviewed by two additional coders from October 2022 to March 2023. Each curated system was assessed to determine coverage of PR across five system-types (probability-based, case-based, administrative, registry, and multiple-source) compared with the 50 states. The availability of data collection instruments in Spanish was also assessed.

Results: Of 93 active CDC-supported systems assessed, results revealed that PR was not covered in 54% of CDC-supported systems. Comparatively, inclusive coverage of all 50 states was only lacking in 33% of CDC-supported systems. Of the 32 CDC-supported systems in PR that could be coded for language, only 53% had data collection instruments in Spanish.

Conclusions: There are significant gaps in the coverage of PR within CDC-supported systems. Future efforts must be made to identify the reasons for this exclusion and increase the territory's representation within these essential public health data systems.