Food Security Has Health Implications for Black Cancer Survivors

A new study provided evidence that Black-White racial disparities in health care utilization and health outcomes persist among cancer survivors. This study specifically focused on the role of food security status (FSS) and showed that a higher proportion of Black cancer survivors reported very low food security compared with Whites.

“Food insecurity, defined as the inability to acquire nutritionally adequate food for all household members consistently, has been associated with an increased prevalence of chronic diseases such as cancer,” study authors explained. “Food insecurity could affect health outcomes and health care use through several mechanisms.”

This study was designed to explore the relationship between race, FSS, and health care utilization or self-reported health among cancer survivors. Researchers used data from the 2011-2018 National Health Interview Survey, which uses the U.S. Department of Agriculture 10-item food security survey to assess family FSS over the past 30 days. The study included 13,434 cancer survivors; 12,063 were White.

The majority of White patients (86%) and Black patients (67%) were food secure. However, compared with their White counterparts, a higher proportion of Black patients reported low (12.98% vs. 4.62%) or very low (10.58% vs. 4.24%; P<0.0001) food security.

Additionally, Black patients were almost twice as likely as White patients to report cost-related medication underuse (CRMU; odds ratio [OR]=1.88; 95% confidence interval [CI], 1.57-2.25). This persisted even after adjustment for all covariates, except for FSS. There was a dose response relationship between FSS and CRMU with increased likelihood of CRMU among those with marginal, low, or very low food security compared with food secure people.

“The finding that FSS explained the relationship between CRMU and racial disparities is significant because food-insecure individuals tend to make trade-offs between food and medications. This trade-off could potentially be worse for Black cancer survivors, who are more likely to experience CRMU in comparison with their White counterparts,” the researchers wrote. “Our study finding, therefore, highlights the potential role of interventions targeting food insecurity in improving medication compliance and reducing related disparities among Black cancer survivors.”

Black patients were also more likely to report cost-related delayed care (OR=1.32; 95% CI, 1.08-1.60) and cost-related forgone care (OR=1.72; 95% CI, 1.41-2.09) compared with White patients, but after adjustment these were not statistically significant.

However, Black patients were more likely to report fair/poor health in compared with White patients (OR=2.41; 95% CI, 2.12-2.73) and this persisted after control for all covariates except for FSS.

“Interventions that target food insecurity could potentially reduce suboptimal health care utilization for both Black and White cancer survivors,” the researchers wrote. “Addressing FSS has implications for Black cancer survivors because of the higher food insecurity rates among Blacks compared with Whites.”