Multilevel Associations of Food Environment and Papillary Thyroid Cancer Outcomes in the United States

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology Pub Date : 2025-06-24 DOI:10.1002/lio2.70186

David J. Fei-Zhang, Eric Pan, Jean-Nicolas Gallant, Andrés M. Bur, Ryan H. Belcher

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引用次数: 0

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

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美国食品环境与甲状腺乳头状癌预后的多层次关联

目的利用美国农业部（USDA）认证的食品环境地图集（FEA）评估不良食品环境与甲状腺乳头状癌（PTC）预后差异的独立关联。方法本回顾性队列研究通过Cox风险和按种族和年龄分层的logistic回归模型，评估2000年至2017年患者的总生存率和3年生存率趋势，以及诊断时食物环境脆弱性/ fea评分升高的肿瘤数量。fea得分基于282个县级变量，包括食品安全、商店-餐馆可用性、SNAP/WIC登记、价格、税收和生产者附近，同时调整了传统的社会决定因素。结果在148,296例患者中，食物环境脆弱性增加与总生存率降低相关（HR 1.06, 95% CI 1.04-1.07）。与白人患者（1.05,1.04-1.07）相比，非白人患者的FEA效应加重（1.08,1.05 - 1.11）。FEA增加也与3年死亡率增加相关（OR 1.05, 95% CI 1.03-1.07）。这些影响在非白人患者（1.06,1.02-1.10）和老年患者（1.05,1.02-1.07）中加剧。食物环境易感性的增加还与患不止一个原发肿瘤的几率增加相关（1.02,95% CI 1.01-1.03）。当按种族和年龄分开分层时，非白人患者（1.03,1.01-1.06）和45岁及以上患者（1.02,1.01-1.03）的饮食环境较差。结论经传统社会决定因素脆弱性调整后，食物环境脆弱性与预后不良相关，且随种族和年龄分层程度不同，影响程度不同。鉴于PTC发病率和严重程度的上升，在为未来的调查和政策提供信息时应考虑食品环境的影响。证据级别III

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