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 aimed 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 to III esophageal cancer were identified from Surveillance Epidemiology and End Results data (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 analyses were used to examine the relationship between food insecurity and surgical intervention and the relationship between food insecurity and recommendation and receipt of surgery, respectively. Multivariable Cox proportional hazards modeling was used to evaluate 5-year cancer-specific survival. Results: A total of 11,114 patients were identified, most of whom were male (78.8%) and non-Hispanic White (77.7%); 44.8% had stage III disease. The odds of undergoing surgical intervention were 27% lower among patients in high-food insecurity counties compared with very low-food insecurity counties (odds ratio, 0.73; 95% CI, 0.64-0.82). The odds of a patient's being recommended surgery but not undergoing it was 38% higher among patients in high-food insecurity counties compared with very low-food insecurity counties (odds ratio, 1.38; 95% CI, 1.08-1.75). Patients in higher-food insecurity counties had worse survival when compared with patients in very low-food insecurity counties (high: hazard ratio, 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.