Kehm Rebecca D, Vilfranc Chrystelle L, McDonald Jasmine A, Wu Hui-Chen
Department of Epidemiology, Mailman School of Public Health of Columbia University, New York, NY 10032, USA.
Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA.
Int J Environ Res Public Health. 2025 Jan 18;22(1):120. doi: 10.3390/ijerph22010120.
Food insecurity (FI) is associated with several known hepatocellular carcinoma (HCC) risk factors, but few studies have directly examined FI in association with HCC risk. We aimed to investigate whether county-level FI is associated with HCC risk. We used data from 21 registries in the Surveillance Epidemiology and End Results database to obtain county-level counts of HCC cases from 2018 to 2021. We obtained the county-level FI rates for 2018-2021 from Feeding America's Map the Meal Gap. We used multi-level Poisson regression models with robust standard errors to calculate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Overall, a one-standard-deviation (SD) increase in county-level FI was associated with an 8% increase in HCC risk in the fully adjusted model (IRR = 1.08, 95% CI = 1.06, 1.10). When stratified by age at diagnosis, a one-SD increase in county-level FI was associated with a 2% higher risk of HCC in the ≥65 age group (IRR = 1.02, 95% CI = 1.00, 1.05) and a 15% higher risk in the <65 age group (IRR = 1.15, 95% CI = 1.11, 1.19; interaction -value < 0.001). If confirmed in other studies, these findings support the need for interventions and policies addressing FI in populations at increased risk for HCC.
粮食不安全（FI）与几种已知的肝细胞癌（HCC）风险因素相关，但很少有研究直接考察FI与HCC风险的关联。我们旨在调查县级FI是否与HCC风险相关。我们使用了监测、流行病学和最终结果数据库中21个登记处的数据，以获取2018年至2021年县级HCC病例数。我们从美国粮食救济组织的“绘制膳食缺口地图”中获取了2018 - 2021年的县级FI率。我们使用具有稳健标准误的多水平泊松回归模型来计算发病率比（IRR）和95%置信区间（CI）。总体而言，在完全调整模型中，县级FI每增加一个标准差（SD），HCC风险增加8%（IRR = 1.08，95% CI = 1.06，1.10）。按诊断时年龄分层时，县级FI每增加一个SD，≥65岁年龄组的HCC风险高2%（IRR = 1.02，95% CI = 1.00，1.05），<65岁年龄组的风险高15%（IRR = 1.15，95% CI = 1.11，1.19；交互P值<0.001）。如果在其他研究中得到证实，这些发现支持需要针对HCC风险增加人群的FI制定干预措施和政策。
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