ABSTRACT Background Nutrition and socioeconomic status are well‐established risk factors for oropharyngeal squamous cell carcinoma (OPSCC) progression and mortality, but the impact of the food environment remains largely understudied. Methods In this retrospective study, race/ethnicity‐stratified inferential and mediation analyses assessed selected clinical outcomes for 70 581 OPSCC patients from the Surveillance, Epidemiology, and End Results. We examined the effects of Food Environment Atlas scores composited from 282‐county‐level variables, adjusted for the effects of traditional social determinants of health. Results Worse food environments were modestly associated with increased risk of overall mortality (aHR‐1.03, 95% CI, 1.02–1.04), 3‐year overall mortality (aOR‐1.04, 95% CI, 1.03–1.05), and advanced stage at diagnosis (aOR‐1.02, 95% CI, 1.01–1.03) in the whole sample, with exacerbated associations across all outcomes among non‐White patients. The food environment was not significantly associated with having more than one primary tumor at diagnosis. Traditional social determinants of health partially mediated mortality, but not staging effects. Conclusions Poor food environments were modestly associated with increased OPSCC mortality and advanced staging, with exacerbated effects in non‐White patients. These retrospective findings support investigations into specific mechanisms of food environment inequity on OPSCC outcomes to guide targeted public health interventions such as subsidized transportation.
Fei‐Zhang et al. (Tue,) studied this question.