Rural and Urban Differences in Vegetable and Fruit Consumption Among Older Cancer Survivors in the Deep South: An Exploratory Cross-Sectional Study.
Rural and Urban Differences in Vegetable and Fruit Consumption Among Older Cancer Survivors in the Deep South: An Exploratory Cross-Sectional Study.
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DOI：
10.1016/j.jand.2022.01.003
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发表时间：
2022-09
影响因子：
4.8
通讯作者：
Demark-Wahnefried, W.
中科院分区：
文献类型：
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作者：
Harleen Kaur;Fernandez, J. R.;Locher, J. L.;Demark-Wahnefried, W.
癌症幸存者，特别是那些年龄较大的人，经历了更多的共病和继发性癌症的风险。建议采用富含蔬菜和水果(V&F)的多样化饮食模式来增进健康。然而，农村和城市的V&F摄入量可能会有所不同。我们的目标是评估居住在城市和农村指定地区的老年癌症幸存者在V&F消费方面的差异，并探索是否存在性别、种族和癌症类型的差异。这是一项横断面二次分析。从2016年10月至2019年11月，获得了从2016年10月到2019年11月对阿拉巴马州731名符合联邦医疗保险资格的癌症幸存者的筛查数据。V&F的摄入量是由美国国家癌症研究所的饮食筛查者在美国餐桌上吃的两项食物来衡量的。使用美国农业部的农村-城市通勤区编码方案，使用5个不同的分类(A到E)，在邮政编码级别对农村和城市住宅进行编码。性别、种族和癌症类型分别分为男性或女性，非西班牙裔白人或非西班牙裔黑人，以及胃肠道或其他癌症。采用Kruskal-Wallis秩和和后处理检验来检测V&F消耗的差异(α<；0.05)。研究样本主要是女性(66.2%)和非西班牙裔白人(78.1%)；平均年龄为70岁，报告的平均V&F摄入量为1.47杯/d。生活在与世隔绝的小农村城镇的癌症幸存者的V&F消费量大约是生活在其他地方的幸存者的一半；因此，在专门考虑这一亚组的模型中发现了统计上显著的城乡差异，即城乡通勤区分类A和E。非西班牙裔黑人的V&F消费量(1.32±0.98杯/天)也显著低于非西班牙裔白人幸存者(1.51±1.10杯/天)(P=.0456)；然而，性别和癌症类型没有发现统计上的差异。在今后的研究中，对农村指定区域内的可变性进行分析是很重要的。此外，需要更多地了解对最弱势群体，即老年、非西班牙裔黑人癌症幸存者以及居住在与世隔绝的小农村城镇的人的V&F消费产生不利影响的因素，以便最有针对性地采取未来的干预措施。临床试验网站：NCT02985411。
Cancer survivors, especially those who are older, experience increased comorbidity and risk for secondary cancers. A varied dietary pattern rich in vegetables and fruits (V&F) is recommended to improve health. However, V&F intake can differ by rural vs urban status. Our objective was to assess the differences in V&F consumption among older cancer survivors residing in urban- and rural-designated areas, and to explore whether differences exist according to sex, race, and cancer type. This was a cross-sectional secondary analysis. Screening data from the Harvest for Health trial were obtained from October 2016 to November 2019 on 731 Medicare-eligible cancer survivors across Alabama. V&F consumption was measured by 2 items from the National Cancer Institute’s dietary screener Eating at America’s Table. Rural and urban residence was coded at the ZIP-code level using the US Department of Agriculture’s Rural-Urban Commuting Area coding schema using 5 different classifications (A through E). Sex, race, and cancer type were dichotomized as male or female, non-Hispanic White or non-Hispanic Black, and gastrointestinal or other cancers, respectively. Kruskal-Wallis rank sum and post-hoc tests were performed to detect differences in V&F consumption (α < .05). The study sample was largely female (66.2%) and non-Hispanic White (78.1%); mean age was 70 years and reported average V&F intake was 1.47 cups/d. V&F consumption of cancer survivors living in isolated, small, rural towns was roughly one-half that consumed by survivors living elsewhere; thus, statistically significant rural–urban differences were found in models that accounted specifically for this subgroup, that is, Rural-Urban Commuting Area categorizations A and E. V&F consumption also was significantly lower in non-Hispanic Black (1.32 ± 0.98 cups/d) than non-Hispanic White survivors (1.51 ± 1.10 cups/d) (P = .0456); however, no statistically significant differences were detected by sex and cancer type. Analyses that address the variability within rural-designated areas are important in future studies. Moreover, a greater understanding is needed of factors that adversely affect V&F consumption of those most vulnerable, that is, older, non-Hispanic Black cancer survivors, as well as those living in isolated, small, rural towns to best target future interventions. ClinicalTrials.gov: NCT02985411.