Association between food insecurity and frailty among older adults with gastrointestinal malignancies: The CARE Registry.

Abstract

12046 Background: Food insecurity is associated with higher gastrointestinal (GI) cancer mortality, but its association with frailty, a known predictor of premature mortality among older adults with cancer, is less understood. Our objective was to evaluate the association between food insecurity and frailty among older adults with GI malignancies. Methods: In this cross-sectional analysis, we included 424 older adults ≥60y recently diagnosed with GI cancer undergoing self-reported geriatric assessment (GA) at their first pre-chemotherapy visit to the University of Alabama at Birmingham oncology clinic. Food insecurity was the exposure of interest, defined using the 2019 United States Department of Agriculture Economic Research Service (USDA ERS) Low-Income, Low-Access (LILA) measure, which classifies census tracts based on income and/or access to food stores at various distances by urban-rural status. The primary outcome was frailty measured via the CARE Frailty Index, a composite measure based on the proportion of deficits across several GA measures (44 items in total). Frailty was dichotomized as frail or robust/pre-frail. We examined the association between LILA and frailty with modified Poisson regression accounting for census tract clustering. Results: Median age at study participation was 69 (IQR: 64, 76), 56.6% were male, 27.2% were non-Hispanic black, 31.4% had colorectal, 28.1% had pancreatic cancer, and 71.7% presented with stage III/IV disease. LILA versus non-LILA had a higher proportion of participants who were non-Hispanic Black (52.1% vs. 11.0%, p: < 0.001) and lower educated (high school or less: 50.6% vs. 35.0%, p: 0.020). After adjustment for age, race, sex, cancer type and stage, LILA was associated with 37% higher risk of frailty (RR: 1.37, 95% CI: 1.05, 1.80) versus non-LILA. Analysis of LILA sub-categories revealed that the overall effect may be driven by low income + low access at 1 mile for urban/10 miles for rural areas (RR: 1.47, 95% CI: 1.12, 1.94) and low income + low access at 0.5 mile for urban/10 miles for rural areas (RR: 1.39, 95% CI: 1.05, 1.85). Low income + low access at 1 mile for urban/20 miles for rural areas, low income + low access with a vehicle or at 20 miles, low income only, or low access only did not demonstrate a significant difference. Conclusions: Low income and low access to food stores is associated with higher risk of frailty among newly diagnosed older adults with GI cancers prior to systemic treatment. Intervening on food insecurity at the local level, particularly in areas with low income and low access, may be a target for improving rates of frailty among older adults with GI cancers. Future studies are needed to determine causality.