{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:28:25Z","timestamp":1790746105766,"version":"4.1.0"},"reference-count":33,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,4,22]],"date-time":"2024-04-22T00:00:00Z","timestamp":1713744000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Social conditions and dietary behaviors have been implicated in the rising burden of gastrointestinal cancers (GIC). The \u201cfood environment\u201d reflects influences on a community level relative to food availability, nutritional assistance, and social determinants of health. Using the US Department of Agriculture\u2010Food Environment Atlas (FEA), we sought to characterize the association of food environment on GIC presenting stage and long\u2010term survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients diagnosed with GIC between 2013 and 2017 were identified using the SEER database. FEA\u2010scores were based on 282 county\u2010level food security variables, store\u2010restaurant availability, SNAP\/WIC enrollment, pricing\/taxes, and producer vicinity adjusted\u2010for factors of socioeconomic status, race\u2010ethnicity, transportation access, and comorbidities. Relative FEA rankings across US counties were averaged into a composite score and assigned to patients by county\u2010of\u2010residence. The association of FEA, cancer stage, and survival were analyzed using multiple logistic regression and cox\u2010proportional hazard models relative to White\/non\u2010White race\/ethnicity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 287,148 patients, the most common GIC\u2010sites were colon (<jats:italic>n<\/jats:italic>\u2009=\u200997,942, 34%), pancreas (<jats:italic>n<\/jats:italic>\u2009=\u200949,785, 17.3%), liver (<jats:italic>n<\/jats:italic>\u2009=\u200931,098, 11.0%) and esophagus (<jats:italic>n<\/jats:italic>\u2009=\u200916,271, 5.7%). A worse food environment was independently associated with increased odds of late\u2010stage diagnosis (esophageal odds ratio [OR]: 1.03, 95% confidence interval [CI]: 1.01\u20131.05; hepatic OR: 1.06, 95% CI: 1.03\u20131.08; pancreatic OR: 1.04, 95% CI: 1.01\u20131.06) among all patients; in contrast, food environment was associated with colorectal cancer stage among non\u2010White patients only (OR: 1.04, 95% CI: 1.03\u20101.06). Worse food environment was associated with worse 3\u2010year survival (colon OR: 1.03, 95% CI: 1.01\u20131.04; hepatic OR: 1.12, 95% CI: 1.08\u20131.17; gastric OR: 1.07, 95% CI: 1.01\u20131.13). Similar associations were noted relative to overall survival among the entire cohort (biliary tract hazard ratio [HR]: 1.03, 95% CI: 1.01\u20131.05; esophageal HR: 1.02, 95% CI: 1.01\u20131.04; hepatic HR: 1.07, 95% CI: 1.06\u20131.09; pancreatic HR: 1.04, 95% CI: 1.02\u20131.05; rectum HR: 1.03, 95% CI: 1.01\u20101.04; gastric HR: 1.05, 95% CI: 1.03\u20131.07), as well as among non\u2010White patients (biliary HR: 1.04, 95% CI: 1.01\u20101.07; colon HR: 1.03, 95% CI: 1.01\u20131.05; esophageal HR: 1.05, 95% CI: 1.02\u20131.08; hepatic HR: 1.08, 95% CI: 1.06\u20131.10) (all <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.003).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Food environment was independently associated with late\u2010stage tumor presentation and worse 3\u2010year and overall survival among GIC patients. Interventions to address inequities across communities relative to food environments are needed to alleviate disparities in cancer care.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.27656","type":"journal-article","created":{"date-parts":[[2024,4,22]],"date-time":"2024-04-22T18:50:02Z","timestamp":1713811802000},"page":"1490-1500","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The associations of food environment with gastrointestinal cancer outcomes in the United States"],"prefix":"10.1002","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4485-8274","authenticated-orcid":false,"given":"David J.","family":"Fei\u2010Zhang","sequence":"first","affiliation":[{"name":"Northwestern University Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel J.","family":"Schellenberg","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Bentrem","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Surgical Oncology Northwestern University Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey D.","family":"Wayne","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Surgical Oncology Northwestern University Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7994-9870","authenticated-orcid":false,"given":"Timothy M.","family":"Pawlik","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Surgical Oncology The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center Columbus Ohio 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