Long-term Geospatial Access to Food Environment and Breast Cancer Risk in Metropolitan Chicago

Neighborhood food environments are recognized as important structural determinants of health, yet their long-term impact on cancer outcomes remains poorly understood. Previous studies have cross-sectionally measured exposure at diagnosis, providing only a snapshot of exposure. This dissertation addressed this gap by examining how long-term cumulative access to healthy and less healthy food outlets influences breast cancer incidence and survival in Metropolitan Chicago from 1990 to 2019. Using data from a large case–control cohort (~32,900 participants; 7,682 cases with frequency matched controls), thirty years of residential histories were linked to the annual National Establishment Time Series (NETS) database of food outlets. Food access was quantified using nearest-distance and inverse-distance-weighted (IDW) measures for walking (1.5 miles) and driving (5 miles), capturing realistic neighborhood access over time using Esri’s Network Analysis. IDW captured both density and proximity, whereas nearest distance reflected proximity to the nearest outlet. Multivariable logistic regression, causal mediation, and Cox proportional hazards models were used to estimate associations, adjusting for individual and neighborhood characteristics. Greater access to healthy outlets was associated with lower breast cancer incidence, and vice versa for less healthy outlets. These relationships were strongest for nearest-distance measures. Obesity did not meaningfully mediate these associations, suggesting that food environments may influence breast cancer risk through mechanisms beyond adiposity, such as diet quality or inflammation. In survival analyses, greater pre-diagnostic access to healthy food outlets was modestly associated with lower breast cancer mortality, whereas greater access to less healthy outlets predicted poorer survival. This work is innovative in integrating three decades of geospatial and residential data to measure cumulative, dynamic food environments across the cancer continuum. Findings demonstrate that nearest-distance measures more effectively capture meaningful exposure than aggregated IDW metrics. Together, results highlight that obesity may not be the pathway linking food access to breast cancer and underscore the importance of addressing neighborhood food environments through structural, place-based strategies to reduce breast cancer risk, improve survival, and promote health equity.

Author dc:creator

• Niyati Mohan Sudhalkar (23292103)

• Health Sciences, Epidemiology
• Cancer Research

Statement dc:rights

• In Copyright
• Open Access after 2028-01-01

DOI dc:identifier

https://doi.org/10.25417/uic.31451800.v1

OAI identifier oai:identifier

oai:figshare.com:article/31451800