Risk of Food Insecurity and Stratified difference for Bronchus and lung cancer-related mortality: County-Level Evidence from the United States

<title>Abstract</title> <p>Background Bronchus and lung cancer remains the leading cause of cancer-related mortality in the United States. Although mortality has declined over recent decades, substantial geographic and socioeconomic disparities persist. Food insecurity and poor food environments may represent important contextual determinants of cancer outcomes, but their association with bronchus and lung cancer-related mortality at the county level remains insufficiently investigated. Methods County-level bronchus and lung cancer-related mortality data from 1999 to 2024 were obtained from CDC WONDER. Food insecurity percentage (FI%) and Food Environment Index (FEI) were obtained from County Health Rankings. Negative binomial regression models were used to evaluate the associations of FI% and FEI with mortality, with sequential adjustment for demographic, socioeconomic, health-related, environmental and SVI covariates. Stratified temporal trends were further assessed by age, sex, race/ethnicity, and urban–rural status. Result From 1999 to 2024, 3,906,674 bronchus and lung cancer-related deaths were recorded among U.S. adults. The overall age-adjusted mortality rate declined significantly, with an average annual percentage change of -2.68% (95% CI: -2.97 to -2.38; p &lt; 0.01). Counties with higher FI% and lower FEI generally had greater socioeconomic and health-related vulnerability. After full adjustment, each 1-percentage-point increase in FI% was associated with a 1.17% increase in mortality (95% CI: 0.82%–1.53%; p &lt; 0.001), and each 1-unit decrease in FEI was associated with a 4.31% increase in mortality (95% CI: 2.91%–5.71%; p &lt; 0.001). Stratified analyses showed declining mortality across major demographic and geographic subgroups, but the magnitude of decline varied. Conclusion Higher county-level food insecurity and poorer food environments were independently associated with increased bronchus and lung cancer-related mortality. Incorporating food security and healthy food access into lung cancer prevention strategies may help reduce mortality disparities.</p>