Various Socioeconomic, Geographic Variables Associated with Poor Diet Quality


New data suggest race and ethnicity, income, education, rural vs urban residence, and living in a food desert all were independently associated with poor diet quality.

Marjorie L. McCullough, ScD, RD

Marjorie L. McCullough, ScD, RD

Multiple individual-level socioeconomic and geographic variables were independently associated with poor diet quality among a large, diverse cohort in the United States, according to new findings.

Data show poorer diet quality was found among participants who were younger, American Indian or Alaska Native or Black, had lower income, had lower educational attainment, lived in a rural area, and lived in a food desert.

“These and other recommendations emphasize the need to examine the social, economic, and environmental contexts that may determine our dietary and lifestyle patterns, which also drive existing health disparities in the US, ” wrote study author Marjorie L. McCullough, ScD, RD, Department of Population Science, American Cancer Society.

McCullough and colleagues noted a greater understanding of the way social, economic, and environmental factors affect diet quality may be beneficial in addressing health disparities and advancing health equity.

The current study aimed to identify socioeconomic and geographic factors associated with lower diet quality in the American Cancer Society Cancer Prevention Study-3, a large prospective cohort of adults in the US. Nearly 300,000 adult aged 30 to 65 years with no history of cancer from 35 states, the District of Columbia, and Puerto Rico were identified between 2006 - 2013.

They were required to complete a validated food frequency questionnaire between 2015 and 2017, while data were analyzed from February - November 2021. Main exposures consisted of self-reported race and ethnicity, education, and household income. They utilized the US Department of Agriculture Food Access Research Atlas database classified residence in a food desert.

The study included a final analytic cohort of 155,331 adults with a mean age of 52 years and 123,115 (79.3%) women. The cohort consisted of 1408 American Indian or Alaskan Native Individuals (0.9%); 2721 Asian, Native Hawaiian, or Pacific Islander individuals (1.8%); 3829 Black individuals (2.5%); 7967 Hispanic individuals (5.1%); and 138,166 White individuals (88.9%).

All key exposures were statistically significantly associated with overall poor diet quality, the investigators found. In comparison with White participants, Black participants had a 16% (95% CI, 8% - 25%) higher risk of poor diet quality, while Hispanic/Latino had 16% (95% CI, 12% - 21%) lower risk and Asian, Native Hawaiian, and Pacific Islander participants had 33% (95% CI, 26% - 40%) lower risk of poor diet quality.

After controlling for other characteristics, data show rural residence was associated with a 61% (95% CI, 48% - 75%) higher risk of poor diet quality, and living in a food desert was associated with a 17% (95% CI, 12 -  22%) higher risk.

They found higher income and education were inversely and independently associated with risk of poor diet quality and varied by race and ethnicity (income: P for interaction = .01; education: P for interaction <.001).

McCullough noted that further research is needed to understand social constructs leading to diet quality and the potential barriers to consuming healthier foods among individuals with poor diet quality.

These factors could be targeted for improved messaging, behavioral interventions, programs, and policies for everyone to have an equal opportunity to eat a healthy diet,” McCullough concluded.

The study, “Association of Socioeconomic and Geographic Factors With Diet Quality in US Adults,” was published in JAMA Network Open.

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