County-level food insecurity to predict cancer incidence and mortality in the United States, 2015-2020.

Abstract

10539 Background: Modifiable dietary patterns incorporating inexpensive, calorie-dense, processed foods and meals low in fiber and other nutrients are associated with development of cancer. Inadequate access to quality nutrition is a crucial but underappreciated social determinant of health and predictor of poor cancer outcomes. We investigated the impact of county-level food insecurity on age-adjusted incidence and mortality rates (AAIR, AAMR) for all cancers. Methods: We linked county-level cancer incidence and mortality rates for 2015-2020 from NCI State Cancer Profiles to food insecurity measures from Feeding America and County Business Patterns. Measures included percentage of individuals experiencing food insecurity (as defined by USDA), percentage on Supplemental Nutrition Assistance Program (SNAP) benefits, average cost per meal, and density of fast-food restaurants. AAIR and AAMRs of all cancers per 100,000 individuals were compared between 1st and 4th quartiles for each measure using robust linear regression models with log transformation and population weights. Results: There was an annual average of 1,728,431 cancer diagnoses with AAIR 449 and 599,666 deaths with AAMR 149. Highest AAIRs were observed in >50y (1351), men (488), non-Hispanic Whites (467), and urban counties (459). This differed from highest AAMR groups including >50y (502), men (178), non-Hispanic Blacks (175), and rural counties (168) suggesting factors of increased disease severity or decreased access to care in the latter. Both AAIRs and AAMRs increased significantly when moving from least to most insecure counties, as defined by overall food insecurity, higher proportion of population on SNAP, higher fast-food density, and lower meal cost. AAMRs and AAIRs for lung cancer and CRC, and for rural residents were most exacerbated by changes in all measures of food insecurity, even when adjusting for screening rates for CRC in low access areas. Conclusions: Our study highlights the most food insecure counties have higher cancer incidence and even greater mortality burden. We recognize food insecurity as a proxy for socioeconomic disadvantage prior to and during cancer treatment. These results encourage prioritization of policies that optimize food assistance programs and clinical practices that incorporate food insecurity-related screenings in care delivery models. [Table: see text]