Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
Department of Epidemiology, University of Florida, Gainesville, FL, USA.
Support Care Cancer. 2024 Apr 25;32(5):309. doi: 10.1007/s00520-024-08495-2.
To investigate the association of food insecurity with overall and disease-specific mortality among US cancer survivors.
Data from the National Health and Nutrition Examination Survey (NHANES 1999-2018) were used to examine the impact of food insecurity on mortality risks among cancer survivors in the US. Study participants aged ≥ 20 years who had a history of cancer and completed the Adult Food Security Survey Module were included. Mortality data [all-cause, cancer, and cardiovascular (CVD) specific] through December 31, 2019 were obtained through linkage to the National Death Index. Using multivariable Cox proportional hazard regression, hazard ratios of mortality based on food security status were estimated.
Among 5032 cancer survivors (mean age 62.5 years; 58.0% women; 86.2% non-Hispanic White), 596 (8.8%) reported food insecurity. Overall, 1913 deaths occurred (609 cancer deaths and 420 CVD deaths) during the median follow-up of 6.8 years. After adjusting for age, food insecurity was associated with a higher risk of overall (HR = 1.93; 95% CI = 1.56-2.39), CVD-specific (HR = 1.95; 95% CI = 1.24-3.05), and cancer-specific (HR = 1.70; 95% CI = 1.20-2.42) mortality (P < 0.001). However, after adjusting for socioeconomic characteristics and health-related factors (physical activity, diet quality measured by healthy eating index), the association between food insecurity and overall mortality was no longer statistically significant.
Food insecurity was associated with a greater risk of overall mortality among cancer survivors. Further studies are needed to confirm these findings and evaluate whether the observed association represents a causal phenomenon and, if so, whether the effect is modifiable with food assistance programs.
调查美国癌症幸存者中食物不安全与全因和特定疾病死亡率的关联。
利用 1999 年至 2018 年国家健康和营养调查（NHANES）的数据，研究了食物不安全对美国癌症幸存者死亡风险的影响。研究纳入了年龄≥20 岁、有癌症病史且完成成人食物安全调查模块的参与者。通过与国家死亡指数链接，获得截至 2019 年 12 月 31 日的死亡数据（全因、癌症和心血管疾病[CVD]特定）。使用多变量 Cox 比例风险回归，估计基于食物安全状况的死亡率风险比。
在 5032 名癌症幸存者（平均年龄 62.5 岁；58.0%为女性；86.2%为非西班牙裔白人）中，有 596 人（8.8%）报告食物不安全。在中位随访 6.8 年期间，共有 1913 人死亡（609 例癌症死亡，420 例 CVD 死亡）。在校正年龄后，食物不安全与全因（风险比[HR] = 1.93；95%置信区间[CI] = 1.56-2.39）、CVD 特定（HR = 1.95；95% CI = 1.24-3.05）和癌症特定（HR = 1.70；95% CI = 1.20-2.42）死亡率的风险增加相关（P < 0.001）。然而，在校正社会经济特征和健康相关因素（体力活动、健康饮食指数衡量的饮食质量）后，食物不安全与全因死亡率之间的关联不再具有统计学意义。
食物不安全与癌症幸存者的全因死亡率增加相关。需要进一步研究来证实这些发现，并评估观察到的关联是否代表因果关系，如果是，是否可以通过食物援助计划来改变这种关联。
