Food security status and breast cancer screening among women in the United States: Evidence from the Health and Retirement Study and Health Care and Nutrition Study

Abstract

Purpose: To assesses the impact of food insecurity on biennial breast cancer screenings (i.e., mammography or breast x-ray) among older women in the United States (US).Methods: Data from the 2014 and 2016 waves of the Health and Retirement Study and the 2013 Health Care and Nutrition Study were used. The analyses were limited to a nationally representative sample of 2,861 women between 50 to 74 years of age, residing in the US. We employed a propensity score weighting method to balance observed confounders between food-secure and food-insecure women and tted a binary logistic regression to investigate population-level estimates for the association between food security and breast cancer screening.Results: Food insecurity was signi cantly associated with failure to obtain a mammogram or breast x-ray within the past two years. Food-insecure women had 54% lower odds of reporting breast cancer screening in the past two years (OR=0.46; 95% CI: 0.30-0.70, P-value <.001) as compared to food-secure women. Additional factors associated with a higher likelihood of receiving breast cancer screenings included greater educational attainment, higher household income, regular access to health care/advice, not smoking, and not being physically disabled or experiencing depressive symptoms. Conclusion:Results demonstrate a socioeconomic gradient existing in regard to the utilization of regular breast cancer screenings among women. Those who tend to have lower education, lower-income and lack of reliable healthcare access are more likely to be food insecure. Thus, more likely to face the nancial, logistical, or environmental barriers in obtaining screening services that accompany food insecurity.

Integrating Social Care into Healthcare: A Review on Applying the Social Determinants of Health in Clinical Settings

“…Food insecurity and housing instability are determinants of chronic diseases, childhood developmental issues, adverse childhood experiences (ACEs), and multigenerational poverty. Being food-insecure is associated with cardiovascular disease [26], poor control of blood sugar [27], and delays in seeking and following treatment [24,28,29]. To illustrate, almost 45% of deaths from heart disease and diabetes are attributable to diets high in sodium and processed meat, but low in fruits, vegetables, nuts, and seeds [26].…”

“…To illustrate, almost 45% of deaths from heart disease and diabetes are attributable to diets high in sodium and processed meat, but low in fruits, vegetables, nuts, and seeds [26]. Additionally, Mahmood et al [28] found that 50-to-74-year-old women experiencing food insecurity were 54% less likely to get a timely mammogram in the past two years-representing missed prevention opportunities that place women at an increased risk due to diagnostic delays. The barriers to timely breast cancer screenings were a function of the social determinants of lower education, lower income, lack of access to care, food insecurity, and the lack of awareness about cancer screening guidelines [28].…”

“…Additionally, Mahmood et al [28] found that 50-to-74-year-old women experiencing food insecurity were 54% less likely to get a timely mammogram in the past two years-representing missed prevention opportunities that place women at an increased risk due to diagnostic delays. The barriers to timely breast cancer screenings were a function of the social determinants of lower education, lower income, lack of access to care, food insecurity, and the lack of awareness about cancer screening guidelines [28]. Conversely, timely breast cancer screenings were associated with higher education, higher household income, and regular access to healthcare and advice [28].…”

“…The barriers to timely breast cancer screenings were a function of the social determinants of lower education, lower income, lack of access to care, food insecurity, and the lack of awareness about cancer screening guidelines [28]. Conversely, timely breast cancer screenings were associated with higher education, higher household income, and regular access to healthcare and advice [28].…”

“…SDH screenings among pregnant women can improve two-generations-worth of health outcomes while simultaneously strengthening the healthcare system [73,83]. SDH screenings helped in detecting specific social needs, such as food insecurity and/or housing instability [28,64,79], which negatively affected cancer screening behavior, chronic disease outcomes, and smoking-related diseases [26,28,63,64,68,75].…”