Multilevel Associations of Food Environment and Papillary Thyroid Cancer Outcomes in the United States
ABSTRACT Objective To assess the independent associations of poor food environment with differences in papillary thyroid carcinoma (PTC) outcomes using the United States Department of Agriculture (USDA)‐validated Food Environment Atlas (FEA). Methods This retrospective cohort study assessed patients...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-06-01
|
| Series: | Laryngoscope Investigative Otolaryngology |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/lio2.70186 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849430392576147456 |
|---|---|
| author | David J. Fei‐Zhang Eric Pan Jean‐Nicolas Gallant Andrés M. Bur Ryan H. Belcher |
| author_facet | David J. Fei‐Zhang Eric Pan Jean‐Nicolas Gallant Andrés M. Bur Ryan H. Belcher |
| author_sort | David J. Fei‐Zhang |
| collection | DOAJ |
| description | ABSTRACT Objective To assess the independent associations of poor food environment with differences in papillary thyroid carcinoma (PTC) outcomes using the United States Department of Agriculture (USDA)‐validated Food Environment Atlas (FEA). Methods This retrospective cohort study assessed patients from 2000 to 2017 for trends in overall and 3‐year survival, and the number of tumors at diagnosis with increasing food environment vulnerability/FEA‐scores by Cox hazards and logistic regression models stratified by race‐ethnicity and age. FEA‐scores were based on 282 county‐level variables of food security, store‐restaurant availability, SNAP/WIC enrollment, pricing, taxes, and producer vicinity while adjusting for traditional social determinant factors. Results Among 148,296 patients, increased food environment vulnerability was associated with decreased overall survival (HR 1.06, 95% CI 1.04–1.07). These FEA effects were exacerbated among non‐White patients (1.08, 1.05–1.11) compared to White patients (1.05, 1.04–1.07). Increased FEA was also associated with increased 3‐year mortality (OR 1.05, 95% CI 1.03–1.07). These effects were exacerbated among non‐White (1.06, 1.02–1.10) and older patients (1.05, 1.02–1.07). Increased food environment vulnerability was additionally associated with increased odds of having more than one primary tumor (1.02, 95% CI 1.01–1.03). When stratified separately for race and for age, worse food environment was associated with non‐White patients (1.03, 1.01–1.06) and patients aged 45 years and older (1.02, 1.01–1.03). Conclusions Food environment vulnerability was associated with poorer prognosis after adjusting for traditional social determinant vulnerabilities, with varying magnitude upon stratification of race and age. Given PTC's rise in incidence and severity, the effects of food environment should be considered when informing future investigation and policy. Level of Evidence III |
| format | Article |
| id | doaj-art-d86df526dcc94d7ebd0b429cda7e5c2c |
| institution | Kabale University |
| issn | 2378-8038 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Laryngoscope Investigative Otolaryngology |
| spelling | doaj-art-d86df526dcc94d7ebd0b429cda7e5c2c2025-08-20T03:28:00ZengWileyLaryngoscope Investigative Otolaryngology2378-80382025-06-01103n/an/a10.1002/lio2.70186Multilevel Associations of Food Environment and Papillary Thyroid Cancer Outcomes in the United StatesDavid J. Fei‐Zhang0Eric Pan1Jean‐Nicolas Gallant2Andrés M. Bur3Ryan H. Belcher4Department of Otolaryngology – Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USAMedical College of Georgia – Augusta University Augusta Georgia USADepartment of Otorhinolaryngology – Head & Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USADepartment of Otolaryngology‐Head and Neck Surgery University of Kansas School of Medicine Kansas City Kansas USADepartment of Otolaryngology‐Head & Neck Surgery Vanderbilt University Medical Center Nashville Tennessee USAABSTRACT Objective To assess the independent associations of poor food environment with differences in papillary thyroid carcinoma (PTC) outcomes using the United States Department of Agriculture (USDA)‐validated Food Environment Atlas (FEA). Methods This retrospective cohort study assessed patients from 2000 to 2017 for trends in overall and 3‐year survival, and the number of tumors at diagnosis with increasing food environment vulnerability/FEA‐scores by Cox hazards and logistic regression models stratified by race‐ethnicity and age. FEA‐scores were based on 282 county‐level variables of food security, store‐restaurant availability, SNAP/WIC enrollment, pricing, taxes, and producer vicinity while adjusting for traditional social determinant factors. Results Among 148,296 patients, increased food environment vulnerability was associated with decreased overall survival (HR 1.06, 95% CI 1.04–1.07). These FEA effects were exacerbated among non‐White patients (1.08, 1.05–1.11) compared to White patients (1.05, 1.04–1.07). Increased FEA was also associated with increased 3‐year mortality (OR 1.05, 95% CI 1.03–1.07). These effects were exacerbated among non‐White (1.06, 1.02–1.10) and older patients (1.05, 1.02–1.07). Increased food environment vulnerability was additionally associated with increased odds of having more than one primary tumor (1.02, 95% CI 1.01–1.03). When stratified separately for race and for age, worse food environment was associated with non‐White patients (1.03, 1.01–1.06) and patients aged 45 years and older (1.02, 1.01–1.03). Conclusions Food environment vulnerability was associated with poorer prognosis after adjusting for traditional social determinant vulnerabilities, with varying magnitude upon stratification of race and age. Given PTC's rise in incidence and severity, the effects of food environment should be considered when informing future investigation and policy. Level of Evidence IIIhttps://doi.org/10.1002/lio2.70186food environmentnutritionpapillary thyroid cancerretrospective cohortsocial determinants of health |
| spellingShingle | David J. Fei‐Zhang Eric Pan Jean‐Nicolas Gallant Andrés M. Bur Ryan H. Belcher Multilevel Associations of Food Environment and Papillary Thyroid Cancer Outcomes in the United States Laryngoscope Investigative Otolaryngology food environment nutrition papillary thyroid cancer retrospective cohort social determinants of health |
| title | Multilevel Associations of Food Environment and Papillary Thyroid Cancer Outcomes in the United States |
| title_full | Multilevel Associations of Food Environment and Papillary Thyroid Cancer Outcomes in the United States |
| title_fullStr | Multilevel Associations of Food Environment and Papillary Thyroid Cancer Outcomes in the United States |
| title_full_unstemmed | Multilevel Associations of Food Environment and Papillary Thyroid Cancer Outcomes in the United States |
| title_short | Multilevel Associations of Food Environment and Papillary Thyroid Cancer Outcomes in the United States |
| title_sort | multilevel associations of food environment and papillary thyroid cancer outcomes in the united states |
| topic | food environment nutrition papillary thyroid cancer retrospective cohort social determinants of health |
| url | https://doi.org/10.1002/lio2.70186 |
| work_keys_str_mv | AT davidjfeizhang multilevelassociationsoffoodenvironmentandpapillarythyroidcanceroutcomesintheunitedstates AT ericpan multilevelassociationsoffoodenvironmentandpapillarythyroidcanceroutcomesintheunitedstates AT jeannicolasgallant multilevelassociationsoffoodenvironmentandpapillarythyroidcanceroutcomesintheunitedstates AT andresmbur multilevelassociationsoffoodenvironmentandpapillarythyroidcanceroutcomesintheunitedstates AT ryanhbelcher multilevelassociationsoffoodenvironmentandpapillarythyroidcanceroutcomesintheunitedstates |