THE ASSOCIATION OF FOOD INSECURITY AND SURGICAL OUTCOMES AMONG PATIENTS UNDERGOING SURGERY FOR COLORECTAL CANCER
Lovette Azap*, Selamawit Woldesenbet, Chinaemelum C. Akpunonu, Laura Alaimo, Yutaka Endo, Henrique Araujo Lima, Syed Husain, Emily Huang, Alan Harzman, Lisa Cunningham, Mark Arnold, Matthew Kalady, Zorays Moazzam, Timothy M. Pawlik
The Ohio State University Wexner Medical Center, Columbus, OH
Introduction: Food insecurity (FI) predisposes individuals to suboptimal nutrition, leading to chronic disease and poor longitudinal health outcomes. However, the impact of county-level nutritional disparities on surgical outcomes remains ill-defined. Thus, we sought to assess the impact of county-level food insecurity on patient-level outcomes and survival among patients diagnosed with colorectal cancer.
Methods: Patients who were diagnosed with colorectal cancer between 2010-2015 were identified in the SEER-Medicare Database. Annual county-level food insecurity rates were obtained from the Feeding America: Mapping the Meal Gap report between 2010-2015. Patients were stratified into Low (<10th percentile), Moderate (10-90th percentile) and High (>90th percentile) cohorts based on food insecurity level during the study period. Multiple logistic regression and Cox regression models that adjusted for patient-level covariates were used to assess outcomes and survival relative to FI.
Results: Among 72,354 patients who were diagnosed with colorectal cancer, 14,727 lived in low FI counties, 43,582 lived in moderate FI counties, and 14,045 lived in high FI counties (Figure 1). Compared with patients in low FI counties, high FI patients were more likely to be Non-Hispanic Black (Low: n=741, 5.0%; High: n=3,430, 24.4%), reside in rural areas (Low: n=198, 1.4%; High: n=443, 3.2%), as well as present with advanced stage cancer (Low: n=6,143, 46.4%; High: n=6,097, 47.9%) (all p<0.05). Furthermore, patients who resided in high FI counties had greater odds of undergoing a non-elective surgical procedure (OR: 1.17, 95% CI: 1.09-1.26), while having decreased odds of being discharged to home (OR: 0.85, 95% CI: 0.79-0.91)(both p<0.001). Interestingly, high FI patients also had an increased likelihood of 90-day readmission (OR: 1.11, 95% CI: 1.04-1.19, p=0.002), extended length-of-stay (OR: 1.26, 95% CI: 1.17-1.36, p<0.001), and post-operative complications (OR: 1.11, 95% CI: 1.03-1.19, p=0.002). In turn, compared with individuals living in low FI locations, patients residing in high FI counties were less likely to achieve an "optimal" textbook outcome following resection of colon cancer (OR: 0.81, 95% CI: 0.75-0.87, p<0.001)(Figure 2). Moreover, patients residing in high FI counties were at greater risk for short- (HR: 1.34, 95% CI: 1.19-1.52, p<0.001) and long-term (HR: 1.04, 95% CI: 1.00-1.09, p=0.04) mortality.
Conclusion: County-level food insecurity was markedly associated with higher odds of suboptimal post-operative outcomes and inferior long-term survival among colorectal cancer patients undergoing surgery. These data demonstrate the profound role that inadequate access to nutrition has in perpetuating health disparities. Interventions directed towards mitigating nutritional inequities are needed to improve outcomes among vulnerable colorectal cancer patients.
Figure 1: Percentage of Food Insecurity by County (2010-2015)
Figure 2: Predicted Probabilities of (a) undergoing non-elective surgery (b) being discharged to home (c) achieving a textbook outcome (d) 5-year mortality
Back to 2023 Posters