Abstract B037: Neighborhood Food Swamps and High-Risk Prostate Cancer Among Men in Georgia

Abstract Introduction and objectives Food swamps –areas with a high density of ultra-processed and pro-inflammatory food outlets relative to healthier alternatives –have been implicated in obesity-related malignancies. Quality of diet may influence prostate cancer (PCa) aggressiveness. We hypothesized that higher food swamp (FS) exposure is independently associated with high-risk PCa (HR PCa) and that these associations differ by race. Methods We conducted a retrospective analysis of men diagnosed with prostate cancer (PCa) in Georgia (2000–2022) using Georgia Cancer Registry data. Census tract–level Federal Information Processing Series (FIPS) codes were used to link neighborhood-level food data from the National Neighborhood Data Archive (NaNDA; 1990–2021) and the Modified Retail Food Environment Index (RFEI) with patient-level socioeconomic and clinicopathologic variables. The RFEI, defined as the ratio of ultra-processed food sources to grocery stores, farmers markets, and supermarkets, was categorized into low, moderate, and high exposure levels, with higher scores indicating greater food swamp exposure. Chi-square tests and ANOVA assessed group differences, and logistic regression models estimated odds of HR PCa by continuous and categorical RFEI scores, stratified by race and including an interaction term. Fully adjusted models controlled for age and insurance status. Results Among 154,480 men (95,517 non-Hispanic [NH] White; 55,288 NH Black), 70% (N=108,146) resided in moderate/high FS tracts. 19,314 men in moderate FS and 8,548 men in high FS tracts had HR PCa. For every 1-unit increase in FS score, the odds of high-risk PCa increased by 1% (aOR 1.01 [95% CI 1.01–1.02]; p < 0.001). The continuous FS score ranged from 0 to 17 (median 1.16, mean 1.77; IQR 0.50–2.33). The association attenuated after fully adjusting for demographic and socioeconomic variables (aOR 1.01 [95% CI 1.00-1.02], p=0.08). NHB men living in low (aOR 1.40, [95% CI 1.31 – 1.48]), moderate (aOR 1.45 [95% CI 1.38 – 1.54]), or high (aOR 1.39 [95% CI 1.30 – 1.49]) FS tracts had greater odds of HR PCa than NHW men living in low FS tracts (p<0.001). Conclusion FS exposure was significantly associated with higher odds of HR PCa translating to approximately 19 additional high-risk PCa cases per 10,000 men for every 1-unit increase in FS score. Attenuation after adjustment suggests that the FS exposure may be mediated by sociodemographic factors rather than as an independent determinant. NHB men had 40–45% greater odds of high-risk disease regardless of food environment, underscoring that persistent racial disparities reflect broader structural and systemic inequities. Citation Format: Divya Lagisetti, Samuel Kennedy, Katherine J. Kim, R Seth. Rozelle, Philippe Gaillard, Avirup Guha, Zachary Klaassen, Martha K. Terris, Justin X. Moore, Malcolm Bevel, Ashanda R. Esdaille. Neighborhood Food Swamps and High-Risk Prostate Cancer Among Men in Georgia [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Innovations in Prostate Cancer Research and Treatment; 2026 Jan 20-22; Philadelphia PA. Philadelphia (PA): AACR; Cancer Res 2026;86(2_Suppl):Abstract nr B037.