Living in a food desert in Louisiana and its effects on gynecologic cancer outcomes.

Abstract

Objective: Food insecurity is becoming recognized as an important measure of public health. Louisiana has a poorer health index and a higher food insecurity rate than the national average. This study aims to investigate how living in a food desert affects the stage at diagnosis and 5-year overall survival in patients with gynecologic cancers.

Methods: Data on genital cancers diagnosed between 2015 and 2019 among Louisiana women aged 20 years and older were from the Louisiana Tumor Registry. The food desert data was based on the USDA Food Access Research Atlas (FARA). The covariates included in this study were race, age, insurance status, BMI, tobacco use, and Charlson Comorbidity Index. Univariate, multivariable logistic regression and Cox proportional hazard regression models were employed.

Results: Food insecurity is independently associated with diagnoses at an advanced stage in patients with cervical and uterine cancer (OR = 1.41 [1.01, 1.96] and 1.28 [1.04, 1.58], respectively) after adjusting for covariates. This association was not observed in patients with ovarian cancer (OR = 0.94 [0.64, 1.39]). In evaluating overall survival at 5 years after initial diagnosis, patients living in a food desert have higher mortality rates across cervical, uterine, and ovarian cancers in the univariate analysis (OR = 1.27 [1.01, 1.60], 1.27 [1.07, 1.49], and 1.34 [1.10, 1.65], respectively); however, this significance is diminished in the multivariate analyses.

Conclusions: Food insecurity affects gynecologic cancer morbidity and can offer an important point of intervention to increase cancer prevention initiatives and improve resources for underserved populations.