Neighborhood-Level Food Insecurity and Colorectal Cancer Incidence in Texas: A Spatial Ecological Analysis
Abstract
PURPOSE: Colorectal cancer (CRC) remains a leading cause of cancer morbidity and mortality in the United States. Growing evidence suggests that neighborhood-level social drivers, including food insecurity and rurality, contribute to disparities in CRC burden, yet the joint effects of time-varying food insecurity and CRC remain understudied.
METHODS: We conducted a spatial ecological analysis of CRC incidence across 6,808 census tracts in Texas from 2017 to 2021. Tract-level CRC cases from the Texas Cancer Registry were linked with time-varying food insecurity estimates from Feeding America's Map the Meal Gap and rural and urban classifications based on 2020 Rural-Urban Commuting Area (RUCA) codes. Sequential spatial Poisson models were used to assess associations between food insecurity, rurality and urbanicity, and CRC screening prevalence with CRC incidence.
RESULTS: Higher food insecurity was consistently associated with increased CRC incidence. In the unadjusted model, each one-percentage point increase in food insecurity corresponded to a 1.7% increase in CRC risk (RR = 1.017; 95% CrI, 1.015-1.019). When additional covariates were included, food insecurity was attenuated (RR range: 1.011-1.016). Compared with metropolitan areas, CRC risk was higher in micropolitan, small town, and rural tracts. Screening prevalence among older adults was negatively associated with CRC incidence.
CONCLUSION: Food insecurity is a significant contextual factor that is positively associated…
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