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

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  • Rebecca D. Kehm

    (Department of Epidemiology, Mailman School of Public Health of Columbia University, New York, NY 10032, USA
    Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, 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
    Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA)

  • Hui-Chen Wu

    (Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
    Department of Environmental Health Sciences, Mailman School of Public Health of Columbia University, New York, NY 10032, USA)

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.

Suggested Citation

  • Rebecca D. Kehm & Chrystelle L. Vilfranc & Jasmine A. McDonald & Hui-Chen Wu, 2025. "County-Level Food Insecurity and Hepatocellular Carcinoma Risk: A Cross-Sectional Analysis," IJERPH, MDPI, vol. 22(1), pages 1-14, January.
    • Handle: RePEc:gam:jijerp:v:22:y:2025:i:1:p:120-:d:1569942
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    References listed on IDEAS

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    1. Coleman-Jensen, Alisha & Rabbitt, Matthew P & Gregory, Christian A & Singh, Anita, 2021. "Statistical Supplement to Household Food Security in the United States in 2020," Administrative Publications 327344, United States Department of Agriculture, Economic Research Service.
    2. Mimi Ton & Michael J. Widener & Peter James & Trang VoPham, 2021. "Food Environments and Hepatocellular Carcinoma Incidence," IJERPH, MDPI, vol. 18(11), pages 1-11, May.
    3. Gowda, C. & Hadley, C. & Aiello, A.E., 2012. "The association between food insecurity and inflammation in the US adult population," American Journal of Public Health, American Public Health Association, vol. 102(8), pages 1579-1586.
    4. Coleman-Jensen, Alisha & Rabbitt, Matthew P & Gregory, Christian A & Singh, Anita, 2021. "Household Food Security in the United States in 2020," Economic Research Report 327186, United States Department of Agriculture, Economic Research Service.
    5. Coleman-Jensen, Alisha & Rabbitt, Matthew P. & Gregory, Christian A. & Singh, Anita, 2021. "Statistical Supplement to Household Food Security in the United States in 2020," USDA Miscellaneous 313486, United States Department of Agriculture.
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