Date on Master's Thesis/Doctoral Dissertation

12-2025

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Epidemiology and Population Health

Degree Program

Public Health Sciences with a specialization in Epidemiology, PhD

Committee Chair

DuPre, Natalie

Committee Member

Taylor, Kira

Committee Member

Guinn, Brian

Committee Member

Kavalukas, Sandra

Committee Member

Zhang, Charlie

Author's Keywords

Colorectal cancer outcomes; fast-food consumption; urinary heavy metals; residential fast-food exposures; kentucky cancer registry

Abstract

Background: Colorectal cancer (CRC) is a public health concern. Within the United States (US), fast-food consumption and environmental exposure to heavy metals have increased. The impact of fast-food consumption frequency from fast-food restaurants, residential fast-food exposures, and urinary essential trace heavy metals in relation to CRC outcomes have not yet been rigorously evaluated in the US. Methods: Within the LEAPS-CRC study, we used geographic information systems (GIS) and logistic regression to study the association of fast-food consumption, residential proximity to a fast-food outlet, and urinary essential trace metals with CRC incidence. Additionally, within Kentucky Cancer Registry (KCR) CRC cases, the associations between residential fast-food exposures at diagnosis and CRC-specific mortality and all-cause mortality were examined using GIS and Cox-proportional hazards regression. Results: We observed that daily to weekly consumption of fast food was associated with increased odds of CRC (OR: 2.01; 95%CI: 1.03-3.93; P-value: 0.04) but not residential proximity to a fast-food outlet. Similarly, we observed a suggestive association between higher urinary concentration of copper to zinc ratio (Cu:Zn) and increased odds of CRC (OR: 2.01; 95%CI: 0.91-4.47; P-value: 0.08) but not urinary copper (Cu), zinc (Zn), and nickel (Ni). No significant associations between residential fast-food exposures at diagnosis and CRC-specific mortality was observed. On the contrary, residing within 0.5-miles of a fast-food outlet (HR: 1.07; 95%CI: 1.02-1.11; P-for trend: 0.001), higher fast-food coverage (HR: 1.05; 95%CI: 1.02-1.07; P-value: 0.001) and fast-food density (HR: 1.05; 95%CI: 1.02-1.07; P-value: 0.001) within 1 mile radius were significantly associated with slightly higher hazard of all-cause mortality. Conclusion: This research suggests that daily to weekly consumption of fast food may be associated with higher CRC incidence while residential fast-food exposures may be associated with higher all-cause mortality among CRC cases. Due to limited literature pertaining to fast-food consumption frequency from fast-food restaurants, neighborhood fast-food exposures, and urinary essential trace metals with CRC outcomes, these relationships should be investigated further.

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