Table 2.
Hazard ratios and 95% confidence intervals for mortality according to quarters of ultra-processed food (UPF) consumption
| Energy adjusted ultra-processed food consumption—median (IQR) servings/day | P for trend |
Per difference in medians between quarters 4 and 1 | ||||
|---|---|---|---|---|---|---|
| Quarter 1—3.0 (2.5-3.4) | Quarter 2—4.3 (4.0-4.6) | Quarter 3—5.5 (5.1-5.8) | Quarter 4—7.4 (6.7-8.6) | |||
| Total mortality | ||||||
| No of cases | 11 862 | 11 682 | 12 168 | 12 481 | ||
| Incidence rate per 100 000 person years* | 1472 | 1404 | 1472 | 1536 | ||
| Model 1† | 1 | 1.06 (1.03 to 1.08) | 1.12 (1.09 to 1.15) | 1.22 (1.18 to 1.25) | <0.001 | 1.23 (1.19 to 1.26) |
| Model 2‡ | 1 | 1.04 (1.02 to 1.07) | 1.07 (1.04 to 1.10) | 1.04 (1.01 to 1.07) | 0.005 | 1.04 (1.01 to 1.07) |
| Cancer mortality | ||||||
| No of cases | 3427 | 3260 | 3476 | 3394 | ||
| Incidence rate per 100 000 person years* | 430 | 402 | 414 | 410 | ||
| Model 1† | 1 | 1.01 (0.96 to 1.06) | 1.09 (1.04 to 1.15) | 1.10 (1.05 to 1.16) | <0.001 | 1.12 (1.07 to 1.17) |
| Model 2‡ | 1 | 1.00 (0.95 to 1.04) | 1.04 (0.99 to 1.09) | 0.95 (0.91 to 1.00) | 0.08 | 0.96 (0.91 to 1.00) |
| Cardiovascular mortality | ||||||
| No of cases | 2817 | 2773 | 2799 | 3027 | ||
| Incidence rate per 100 000 person years* | 348 | 334 | 341 | 370 | ||
| Model 1† | 1 | 1.07 (1.01 to 1.12) | 1.09 (1.04 to 1.15) | 1.28 (1.22 to 1.35) | <0.001 | 1.29 (1.22 to 1.36) |
| Model 2‡ | 1 | 1.03 (0.98 to 1.09) | 1.01 (0.96 to 1.07) | 1.05 (0.99 to 1.11) | 0.14 | 1.04 (0.99 to 1.10) |
| Other mortality | ||||||
| No of cases | 5618 | 5649 | 5893 | 6060 | ||
| Incidence rate per 100 000 person years* | 694 | 668 | 717 | 757 | ||
| Model 1† | 1 | 1.08 (1.04 to 1.12) | 1.14 (1.10 to 1.19) | 1.25 (1.21 to 1.30) | <0.001 | 1.40 (1.34 to 1.47) |
| Model 2‡ | 1 | 1.08 (1.04 to 1.12) | 1.11 (1.07 to 1.16) | 1.09 (1.05 to 1.13) | <0.001 | 1.12 (1.06 to 1.17) |
| Respiratory mortality | ||||||
| No of cases | 880 | 922 | 1011 | 1113 | ||
| Incidence rate per 100 000 person years* | 121 | 111 | 118 | 130 | ||
| Model 1† | 1 | 1.13 (1.03 to 1.24) | 1.25 (1.14 to 1.37) | 1.49 (1.36 to 1.63) | <0.001 | 1.80 (1.60 to 2.01) |
| Model 2‡ | 1 | 1.05 (0.95 to 1.15) | 1.10 (1.01 to 1.21) | 1.09 (0.99 to 1.20) | 0.06 | 1.12 (1.00 to 1.27) |
| Neurodegenerative mortality | ||||||
| No of cases | 1633 | 1653 | 1575 | 1482 | ||
| Incidence rate per 100 000 person years* | 181 | 188 | 204 | 202 | ||
| Model 1† | 1 | 1.10 (1.03 to 1.18) | 1.08 (1.00 to 1.15) | 1.10 (1.02 to 1.18) | 0.03 | 1.15 (1.05 to 1.26) |
| Model 2‡ | 1 | 1.16 (1.08 to 1.25) | 1.14 (1.06 to 1.22) | 1.08 (1.01 to 1.17) | 0.10 | 1.09 (0.99 to 1.20) |
IQR=interquartile range.
Multivariable adjusted incidence rate was calculated via several steps: firstly, regression of total UPF intake on full set of covariates in linear regression stratified by cohort and questionnaire cycle to calculate residuals of total UPF intake; secondly, categorization of residuals into quarters; finally, calculation of incidence rate on basis of number of cases and person years across quarters.
Stratified by age (months), questionnaire cycle (two year interval), and cohort and adjusted for total energy intake.
Further adjusted for categorical covariates including race, marital status, physical activity, body mass index, smoking status and pack years, alcohol consumption, physical examination performed for screening purposes, and family history of diabetes mellitus, myocardial infarction, or cancer; for women, also menopausal status and hormone use.