Abstract A075: The Association between Food Deserts, Food Swamps, and Postmenopausal Breast Cancer Mortality in the United States
Authors: Bevel Malcolm , Tsai Meng-Han , Parham April , Andrzejak Sydney , Jones Samantha , Moore Justin X 
Published: February 2024

Abstract
Purpose: Breast cancer (BRCA) is the 4th leading cause of cancer death in the United States (U.S.) and is one of 13 obesity-related cancers. Healthy food consumption is a protective factor shown to decrease obesity risk and postmenopausal BRCA mortality, respectively. However, residing in geographical areas with no access to healthy food options (food deserts) or unhealthy food options (food swamps) reduces access to healthy foods and has been severely understudied. Recently we found a 77% increased odds of overall obesity-related cancer mortality among U.S. counties with the worst food swamp scored counties/county equivalents. This current study examined the association between residing in food swamps and deserts with postmenopausal BRCA mortality. Methods: We conducted a cross sectional/ecological analysis utilizing 2010 – 2020 Center for Disease Control and Prevention postmenopausal BRCA mortality data (restricted to 45+ years old) and aggregated 2012 – 2020 data from the U.S. Department of Agriculture Food Environment Atlas data. Food swamp score (FS) was calculated as the ratio of fast-food and convenience stores to grocery stores and farmer’s markets. Food desert score (FD) was calculated as the proportion of residents living more than one mile (urban) or 10 miles (rural) from a grocery store and household income ≤ 200% of the federal poverty threshold. We categorized FD and FS to low, moderate, or high; higher scores indicated counties with poorer healthy food resources. Multilevel generalized mixed effects models were used to estimate the mentioned association. Results: 2,280 counties/county equivalents with high postmenopausal BRCA mortality rates had higher percentage of non-Hispanic (NH)-Black population (5.80 vs. 2.08), poverty rates (17.2 vs. 14.2), and high food swamp scored areas (39.0 vs. 24.5) versus counties/county equivalents with low postmenopausal BRCA mortality rates (p-value &lt; 0.0001). After adjusting for age, percentage of NH-Blacks per county, and poverty rate, we found 42% increased odds of having high postmenopausal BRCA mortality rates among U.S. counties/county equivalents with high food swamp scores (adjusted odds ratio [AOR] = 1.42; 95% CI: 1.14 – 1.78). Conclusions: Sampled U.S. counties with the poorest food swamp environment had significantly increased odds of postmenopausal BRCA mortality. We suggest that local policymakers and community stakeholders should employ sustainable approaches at combating obesity and BRCA by increasing healthier accessible food sources (e.g. creating more walkable neighborhoods and community gardens).
Citation Format: Malcolm Bevel, Meng-Han Tsai, April Parham, Sydney Andrzejak, Samantha Jones, Justin X Moore. The Association between Food Deserts, Food Swamps, and Postmenopausal Breast Cancer Mortality in the United States [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Breast Cancer Research; 2023 Oct 19-22; San Diego, California. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_1):Abstract nr A075.