Association of Food Insecurity with Reduced History of U.S. Cancer Screening Rates

Abstract

Background: Social determinants of health (SDOH) influence cancer prevention and outcomes. Among SDOH, economic stability—including food insecurity, income, employment, and housing stability—has a major impact on health. However, data linking food security status with cancer screening completion remain limited. We examined whether lower food security status was associated with lower completion of colorectal, breast, cervical, and prostate cancer screening. Methods: We performed a retrospective analysis of the 2018–2023 National Health Interview Survey. Analyses were limited to cancer-specific complete-case cohorts: colorectal (N = 59,849), breast (N = 30,867), cervical (N = 56,229), and prostate (N = 20,518). Food security was categorized as high, marginal, or low/very low. Screening completion was the dependent variable. Multivariable logistic regression estimated adjusted odds ratios (aORs) for screening by food security status, controlling for sociodemographic and clinical covariates. Sensitivity analyses used age-stratified eligibility definitions across survey years. Results: Compared with high food security, marginal food security was associated with lower odds of screening across cancers (aOR range, 0.63–0.88), and low/very low food security showed similar or larger deficits (aOR range, 0.60–0.88). Associations were significant for all four cancers and were similar in sensitivity analyses. Conclusions: Lower food security status was associated with lower completion of cancer screening. Addressing food insecurity may improve screening equity and reduce cancer disparities. Impact: Lower food security status was associated with lower completion of guideline-recommended screening across four cancers, even after multivariable adjustment. Future work should test whether interventions addressing food insecurity can improve screening.