EP831 - Beyond the Grocery Aisle: Exploring Food Access and Colorectal Cancer Burden Across West Virginia

Purpose/Background: Colorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality in West Virginia, a state characterized by high rurality and persistent socioeconomic and food access challenges. Poor nutrition and limited access to healthy foods have been identified as modifiable risk factors influencing cancer prevention and outcomes. This study examined associations between county-level food desert indicators specifically, limited access to healthy foods and the Food Environment Index (FEI), and CRC incidence rates across West Virginia from 2017-2022.

Methods/Interventions: County-level CRC incidence data (2017-2021, per 100,000 population) were obtained from the West Virginia Cancer Registry and stratified by rural versus urban classification. Food environment variables were sourced from the 2019 Us Department of Agriculture Food Access Research Atlas and the County Health Rankings dataset. The proportion of residents with limited access to healthy foods and FEI scores (ranging from 0= worst to 10 = best) were merged with CRC incidence data. Pearson correlation analyses were performed overall and stratified by rural/urban status.

Results/Outcomes: Across 55 counties, CRC incidence ranged from 30.7 to 64.3 per 100,000 (mean=47.9). Limited access to healthy foods ranged widely by county, while FEI scores varied between 6.2 and 8.9. Correlation analyses revealed weak, nonsignificant associations overall:

CRC vs Limited Access %: r = -0.4 (overall), -0.10 (rural), +0.15 (urban)

CRC vs FEI: r = -0.09 (overall), + 0.22 (rural), -0.43 (urban)

A moderate inverse relationship was observed between FEI and CRC incidence in urban counties, suggesting that improved food environments may correspond to lower CRC incidence. No consistent pattern was seen in rural regions.

Conclusion/Discussion: This ecological analysis found no strong linear relationship between food access metrics and CRC incidence at the county level in West Virginia, though trends in urban areas suggest potential protective effects of favorable food environments. The findings highlight the complex interplay between geographic, socioeconomic, and behavioral determinants of cancer risk and the need for more granular, individual-level data. Future research should integrate CRC screening rates, dietary behaviors, and socioeconomic indicators to clarify pathways linking food environment disparities and cancer burden in Appalachia.