County-Level Food Insecurity and Hepatocellular Carcinoma Risk: A Cross-Sectional Analysis

Rebecca D. Kehm, Chrystelle L. Vilfranc, Jasmine A. McDonald and Hui-Chen Wu ()
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Rebecca D. Kehm: Department of Epidemiology, Mailman School of Public Health of Columbia University, New York, NY 10032, USA
Chrystelle L. Vilfranc: Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
Jasmine A. McDonald: Department of Epidemiology, Mailman School of Public Health of Columbia University, New York, NY 10032, USA
Hui-Chen Wu: Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA

IJERPH, 2025, vol. 22, issue 1, 1-14

Abstract: Food insecurity (FI) is associated with several known hepatocellular carcinoma (HCC) risk factors, but few studies have directly examined FI in association with HCC risk. We aimed to investigate whether county-level FI is associated with HCC risk. We used data from 21 registries in the Surveillance Epidemiology and End Results database to obtain county-level counts of HCC cases from 2018 to 2021. We obtained the county-level FI rates for 2018–2021 from Feeding America’s Map the Meal Gap. We used multi-level Poisson regression models with robust standard errors to calculate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Overall, a one-standard-deviation (SD) increase in county-level FI was associated with an 8% increase in HCC risk in the fully adjusted model (IRR = 1.08, 95% CI = 1.06, 1.10). When stratified by age at diagnosis, a one-SD increase in county-level FI was associated with a 2% higher risk of HCC in the ≥65 age group (IRR = 1.02, 95% CI = 1.00, 1.05) and a 15% higher risk in the <65 age group (IRR = 1.15, 95% CI = 1.11, 1.19; interaction p -value < 0.001). If confirmed in other studies, these findings support the need for interventions and policies addressing FI in populations at increased risk for HCC.

Keywords: food insecurity; hepatocellular carcinoma; social determinants of health; health disparities; Surveillance Epidemiology and End Results Program (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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