In a study reported in JAMA Oncology, Bevel et al found that residing in U.S. areas defined as food deserts (less access to grocery stores) or food swamps (high access to fast foods) was associated with an increased risk of obesity-related cancer mortality.
Study Details
The study used Department of Agriculture Food Environment Atlas data from 2012, 2014, 2015, 2017, and 2020 and Centers for Disease Control and Prevention mortality data from 2010 to 2020. A total of 3,038 U.S. counties/county equivalents with complete information on food environment scores and obesity-related cancer mortality data (including 13 cancer types) were included in the analysis. Food swamp score was calculated as the ratio of fast food and convenience stores to grocery stores and farmers’ markets; food desert scores were determined by number of grocery stores within a rural or urban area. Higher food swamp and food desert scores (20.0 to ≥ 58.0) indicated counties with reduced healthy food resources.
Key Findings
Among the 3,038 counties included in the analysis, 758 were in the fourth quartile (highest rates) of obesity-related cancer mortality rates. Compared with counties with lower mortality rates, these counties had a higher proportion of Black persons (3.26% vs 1.77%), higher proportion of persons aged > 65 years (15.71% vs 15.40%), higher poverty rates (19.00% vs 14.40%), higher adult obesity rates (33.00% vs 32.10%), and higher adult diabetes rates (12.50% vs 10.70%).
Age-adjusted odds of counties having high obesity-related cancer mortality rates were increased in counties with high food desert scores (adjusted odds ratio [aOR] = 1.59, 95% confidence interval [CI] = 1.29–1.94) and high food swamp scores (aOR = 1.77, 95% CI = 1.43–2.19) compared with counties with lower scores.
A positive dose-response relationship among three levels of food desert and food swamp scores and obesity-related cancer mortality was observed. For counties with high obesity-related cancer mortality rates, adjusted odds ratios for mortality were 1.43 (95% CI = 1.15–1.78) for moderate and 1.59 (95% CI = 1.28–1.96) for high vs low food desert scores. Similarly, adjusted odds ratios were 1.29 (95% CI = 1.03–1.61) for moderate and 2.10 (95% CI = 1.67–2.63) for high vs low food swamp scores.
The investigators concluded, “The findings of this cross-sectional ecologic study suggest that policymakers, funding agencies, and community stakeholders should implement sustainable approaches to combating obesity and cancer and establishing access to healthier food, such as creating more walkable neighborhoods and community gardens.”
Malcolm Seth Bevel, PhD, MSPH, of the Cancer Prevention, Control and Population Health Program, Georgia Cancer Center, Medical College of Georgia, Augusta, is the corresponding author for the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
