Abstract 2310: Food environment index is inversely associated with cancer survival in North Carolina

Background: Exploring the potential role of the food environment on cancer survival could facilitate prevention and control approaches to improve cancer survivorship. This study examined the associations between food environment index (FEI) and survival for overall cancer in North Carolina. Methods: This retrospective cohort study included 1,292,991 patients diagnosed with overall cancer from January 1, 2000 to December 31, 2022 from the North Carolina Cancer Central Registry. The individual-level demographic, tumor, and treatment information were provided by the North Carolina Cancer Central Registry. FEI and other county-level exposures were obtained from the County Health Rankings & Roadmaps databases. The county-level food environment index is an indicator of access to healthy foods (0 is worst, 10 is best). Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between FEI and cancer survival after adjusting for individual-level and county-level covariates. Results: Higher levels of FEI were associated with a statistically significant better survival for overall cancer (fully adjusted HR for every score increase=0.983, 95% CI 0.979, 0.988; P <0.0001; adjusted HR for the 3rd quartile vs. 1st quartile = 0.98, 95% CI 0.94, 0.99; and adjusted HR for the 4th quartile vs. 1st quartile = 0.95, 95% CI 0.94, 0.96). Conclusion: These results suggest that a healthy food environment, as measured by FEI, may be a protective factor for cancer survival in North Carolina. To improve cancer survival, further strategies to improve food environment at the county level are warranted. Citation Format: Shenghui Wu, Sarah Ulrich, Tinghao Feng, Yanning Liu, Leilani Tseng. Food environment index is inversely associated with cancer survival in North Carolina [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 2310.