ASPO Abstracts
Examining Racial Disparities in the Association between Food Deserts, Food Swamps, and Early-Onset Colorectal Cancer Mortality
Category: Cancer Health Disparities
Conference Year: 2023
Abstract Body:
Purpose: Healthy food consumption is a modifiable factor shown to reduce colorectal cancer (CRC) death, but residing in geographical areas with no access to healthy food options (food deserts) or unhealthy food options (food swamps) reduces healthy food accessibility and has been severely understudied especially among underserved Black-Indigenous Persons of Color (BIPOC). We explored the relationship between residing in food swamps and deserts with risk of early- onset CRC death. Methods: We conducted a retrospective analysis utilizing 2010 – 2020 data from the U.S. Department of Agriculture Food Environment Atlas linked by county codes with patient data years 2010 – 2020 from the Surveillance, Epidemiology, and End Results (SEER) Program. Food swamp score (FS) was calculated as the ratio of fast-food and convenience stores to grocery stores and farmer's markets. Food desert score (FD) was calculated as the proportion of SEER patients living more than one mile (urban) or 10 miles (rural) from a grocery store and household income ≤ 200% of the federal poverty threshold. We categorized FD and FS to low, moderate, or high; higher scores indicated patients living in counties with poorer healthy food resources. Multilevel Cox proportional hazard models were used to estimate the association between FD, FS, and early-onset CRC death. Results: Among 750,498 SEER patients, majority of CRC death was in high FS counties. NH-black patients-high-FS counties had an increased risk of early-onset CRC death (adjusted hazard ratio (aHR) = 1.27, 95% CI = 1.20 – 1.35), while American Indian/Alaskan Natives/Other (AI/AN/Other) patients-moderate-FS counties had reduced risk of early-onset CRC death (aHR = 0.71, 95% CI = 0.53 – 0.96), when compared to NH-white patients-low-FS counties. Similarly, NH- black and Hispanic patients-high FD counties had significantly increased risk of early-onset CRC death. Conclusions: NH-black patients living in the worst food environments had increased risk of early-onset CRC death. We suggest that policymakers and community stakeholders should employ sustainable approaches at combating early-onset CRC in underserved racial communities by increasing healthier accessible food sources (e.g. creating more walkable neighborhoods and community gardens).
Keywords: Food swamps, colorectal cancer, disparities