The Impact of Food Insecurity on the Management and Survival of Stage I-III Esophageal Cancer

BACKGROUND Food insecurity is associated with poor health outcomes, however, the connection with cancer care is not well understood. This study aims to evaluate the impact of county-level food insecurity on the surgical management and survival of patients with esophageal cancer. METHODS Patients with stage I-III esophageal cancer were identified from SEER (2010-2016). County-level food insecurity rates were obtained from the Map the Meal Gap data (2010-2016), divided into quartiles: high, marginal, low, and very low. Multivariable and multinomial logistic regression were used to examine the relationship between food insecurity, and surgical intervention and the recommendation and receipt of surgery, respectively. Multivariable cox proportional hazards modeling was used to evaluate 5-year cancer-specific survival. RESULTS 11,114 patients were identified, of which the majority were male (78.8%), non-Hispanic white (77.7%) with stage III disease (44.8%). The odds of undergoing surgical intervention were 27% lower among patients in high food insecurity counties compared to very low food insecurity counties (OR 0.73, 95%CI 0.64-0.82). The odds of a patient being recommended surgery but not receiving it was 38% higher among patients in high food insecurity counties compared to very low food insecurity counties (OR 1.38, 95%CI 1.08-1.75). Patients in higher food insecurity counties had worse survival when compared to patients in very low food insecurity counties (High: HR 1.26, 95%CI 1.16-1.36). CONCLUSIONS Among patients with esophageal cancer, significant disparities in surgical resection and survival are associated with high county-level food insecurity Interventions focused on these communities may help reduce inequities in esophageal cancer care.