Abstract B137: Examining racial disparities in the association between food swamps, liquor store density, and colorectal cancer mortality among Georgia cancer patients
Authors: Bevel Malcolm S. , Parham April , Sheth Aashka , Tsai Meng-Han , Andrzejak Sydney E. , Jones Samantha R. , Moore Justin X. 
Published: December 2023

Abstract
Introduction: Colorectal cancer (CRC) is the third-most common cancer in the United States (U.S.) and racial/ethnic disparities regarding CRC death continue to persist. Increased healthy food consumption and decreased processed food consumption are key factors in reducing CRC mortality. However, living in geographical areas with no access to healthy food options and more pro-inflammatory foods (i.e. food swamps) decreases healthy food access. The influx of liquor stores, or businesses that advertise and sell unhealthy food products including processed foods and alcohol, may contribute to elevated CRC death. We investigated whether liquor store density modified the association between residing in food swamps with risk of CRC death among a multiethnic sample of cancer patients in Georgia. Methods: We conducted a retrospective cohort analysis utilizing 2012, 2014, 2015, 2017, and 2020 data from the U.S. Department of Agriculture Food Environment Atlas along, U.S. Census County Health Patterns data, and linked them via county FIPS codes with patient data years 2010 – 2020 from the Surveillance, Epidemiology, and End Results (SEER) Program. Food swamp score (FS) was calculated as the ratio of fast-food and convenience stores to grocery stores and farmer’s markets. Liquor store density was calculated as the proportion of beer, wine, and liquor stores to Georgia county populations per 100,000. We categorized FS and liquor store density to low or high; higher scores indicated patients living in counties with poorer healthy food resources. Multilevel Cox proportional hazard models were used to estimate the association between FS, liquor store density and CRC death. Results: Among 56,861 SEER patients in Georgia, majority of CRC death was in high liquor store density counties. NH-Black and Other patients at both levels of FS counties had an increased risk of CRC death (low: adjusted hazard ratio (aHR) = 1.21, 95% CI = 1.16 – 1.26; high: aHR = 1.06, 95% CI = 1.01 – 1.12) when compared to NH-white patients-low-FS counties. In sub-analyses by liquor store density, NH-Black and Other patients-low-FS counties had an increased risk of CRC death among high (aHR = 1.24, 95% CI = 1.19 – 1.31) and low (aHR = 1.12, 95% CI = 1.03 – 1.21) liquor store density counties. Conclusions: NH-Black patients living in the worst food environments, including effect modification by liquor store density, had increased risk of CRC death. We strongly recommend local and state representatives and community stakeholders create and implement sustainable approaches at combating CRC in underserved racial communities by increasing access to healthier food sources (e.g. building more community gardens, fixing barriers to walkability).
Citation Format: Malcolm S. Bevel, April Parham, Aashka Sheth, Meng-Han Tsai, Sydney E. Andrzejak, Samantha R. Jones, Justin X. Moore. Examining racial disparities in the association between food swamps, liquor store density, and colorectal cancer mortality among Georgia cancer patients [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B137.