Shahidul Islam

Supplementary Table S1A shows baseline characteristics of female cancer screening–eligible participants by food security status, reporting median age and unweighted counts with survey-weighted row percentages across high, marginal, and low/very low food security categories.

Supplementary Table S1B shows baseline characteristics of male cancer screening–eligible participants by food security status, reporting median age and unweighted counts with survey-weighted row percentages; age groups below 45 years are retained to demonstrate that no males younger than 45 entered the screening-eligible cohort.

Supplementary Tables S4A–S4D show age-stratified screening frequency by food security status for colorectal, prostate, breast, and cervical cancer screening, respectively, with unweighted counts and survey-weighted percentages within each screening-eligible age group and food security category.

Supplementary Table S5 shows the stepwise derivation of the adult complete-case analytic cohort, including the number and percentage excluded at each stage and the remaining sample size after each exclusion criterion.

Supplementary Table S6 summarizes missing screening outcome data within each cancer-specific eligible cohort, reporting participants without prior cancer, missing and nonmissing screening outcome counts, and the final complete-case sample sizes for breast, cervical, colorectal, and prostate cancer screening.

Background:Social determinants of health (SDOH) influence cancer prevention and outcomes. Among SDOHs, 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 to 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 (aOR) 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.

Supplementary Figure S1 shows the derivation of the Table 1 analytic cohort and the cancer-specific screening and complete-case cohorts used for Tables 2 and 3 from the 2018, 2019, 2021, and 2023 NHIS samples, including exclusions for missing food security data, screening ineligibility, prior cancer, missing screening outcomes, and incomplete covariates.

Supplementary Table S2 compares NHIS screening-question eligibility with USPSTF guideline criteria for breast, colorectal, cervical, and prostate cancer screening across the 2018, 2019, 2021, and 2023 survey years.

Supplementary Table S3 shows screening recency by food security status for colorectal, cervical, breast, and prostate cancer screening, reporting unweighted counts and survey-weighted percentages for participants who were up-to-date, screened but not up-to-date, or never screened.

Background: Social determinants of health (SDOH) influence cancer prevention and outcomes. Among SDOHs, 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 to 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 (aOR) 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.