Examining Racial Disparities in the Association Between Food Swamps and Early-Onset Colorectal Cancer Mortality

Abstract

PURPOSE Colorectal cancer (CRC) mortality is rising among individuals younger than 50 years, and racial disparities in CRC persist. Residing in areas with no access to healthy food (food deserts) is associated with increased risk of CRC death, but the association between food swamps (FSs; areas with more unhealthy food) and CRC is unknown. We sought to examine the relationship of FSs to risk of early-onset CRC (EOCRC) mortality within different racial/ethnic groups. MATERIALS AND METHODS We conducted a retrospective cohort analysis with 2010-2016 EOCRC patient data (N = 7,841) from the Surveillance, Epidemiology, and End Results Program, linked to county-level measures of FS scores data from the US Department of Agriculture Food Environment Atlas (aggregated years 2012, 2014, 2015, and 2017). FS score, or the ratio of fast-food and convenience stores to grocery stores and farmer's markets, was categorized as low, moderate, or high. Higher scores indicated patients living in counties with poorer healthy food resources. We conducted multivariable, multilevel Fine-Gray Cox proportional models to estimate adjusted hazard ratios (aHRs) and associated 95% CIs. RESULTS Non-Hispanic (NH) Black (aHR, 1.38 [95% CI, 1.14 to 1.65]) and Hispanic (aHR, 1.39 [95% CI, 1.12 to 1.73]) patients in high-FS counties had an increased risk of EOCRC death, when compared with NH-White patients in low-FS counties. CONCLUSION NH-Black and Hispanic patients living in the worst food environments had greater risk of EOCRC death versus NH-White patients. Policymakers and stakeholders should employ sustainable approaches at combating EOCRC in underserved racial communities by increasing healthier accessible food sources (eg, community gardens).