TABLE 3.
Risk of CVD, respiratory disease, and cancer mortality by quintiles of diet-quality scores in the Singapore Chinese Health Study participants1
| CVD mortality | Respiratory disease mortality | Cancer mortality | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Quintile (range of scores) | Deaths, n | Person-years | Basic model,2 HR (95% CI) | Full model,3 HR (95% CI) | Deaths, n | Person-years | Basic model,2 HR (95% CI) | Full model,3 HR (95% CI) | Deaths, n | Person-years | Basic model,2 HR (95% CI) | Full model,3 HR (95% CI) |
| AHEI-2010 | ||||||||||||
| Q1 (17.0–44.0) | 1123 | 189,288 | 1.0 | 1.0 | 658 | 189,288 | 1.0 | 1.0 | 1179 | 189,288 | 1.0 | 1.0 |
| Q2 (44.1–48.0) | 1086 | 193,982 | 0.94 (0.87, 1.03) | 0.96 (0.88, 1.04) | 575 | 193,982 | 0.86 (0.77, 0.96) | 0.89 (0.80, 1.00) | 1080 | 193,982 | 0.91 (0.84, 0.99) | 0.95 (0.87, 1.03) |
| Q3 (48.1–51.6) | 988 | 196,858 | 0.86 (0.79, 0.94) | 0.89 (0.81, 0.97) | 561 | 196,858 | 0.83 (0.74, 0.93) | 0.90 (0.80, 1.01) | 1033 | 196,858 | 0.87 (0.80, 0.94) | 0.94 (0.87, 1.02) |
| Q4 (51.7–55.9) | 890 | 199,271 | 0.78 (0.71, 0.85) | 0.82 (0.75, 0.90) | 487 | 199,271 | 0.72 (0.64, 0.81) | 0.80 (0.71, 0.90) | 1065 | 199,271 | 0.89 (0.82, 0.97) | 1.00 (0.92, 1.09) |
| Q5 (56.0–81.0) | 784 | 202,578 | 0.71 (0.65, 0.78) | 0.77 (0.70, 0.85) | 409 | 202,578 | 0.61 (0.54, 0.69) | 0.72 (0.64, 0.82) | 949 | 202,578 | 0.80 (0.73, 0.87) | 0.95 (0.87, 1.04) |
| P-trend | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | 0.55 | ||||||
| aMED | ||||||||||||
| Q1 (0–2) | 1265 | 191,950 | 1.0 | 1.0 | 727 | 191,950 | 1.0 | 1.0 | 1292 | 191,950 | 1.0 | 1.0 |
| Q2 (3) | 1086 | 189,407 | 0.93 (0.85, 1.01) | 0.95 (0.88, 1.04) | 627 | 189,407 | 0.92 (0.83, 1.03) | 0.97 (0.87, 1.08) | 1085 | 189,407 | 0.88 (0.81, 0.96) | 0.93 (0.86, 1.01) |
| Q3 (4) | 1026 | 207,848 | 0.86 (0.79, 0.94) | 0.90 (0.83, 0.98) | 563 | 207,848 | 0.81 (0.73, 0.91) | 0.90 (0.80, 1.01) | 1144 | 207,848 | 0.88 (0.82, 0.96) | 0.98 (0.90, 1.06) |
| Q4 (5) | 788 | 189,321 | 0.79 (0.72, 0.87) | 0.86 (0.78, 0.94) | 404 | 189,321 | 0.70 (0.62, 0.79) | 0.81 (0.71, 0.92) | 932 | 189,321 | 0.83 (0.76, 0.90) | 0.97 (0.88, 1.06) |
| Q5 (6–9) | 706 | 203,452 | 0.69 (0.63, 0.76) | 0.77 (0.70, 0.85) | 369 | 203,452 | 0.60 (0.52, 0.69) | 0.72 (0.63, 0.83) | 853 | 203,452 | 0.72 (0.65, 0.79) | 0.88 (0.80, 0.97) |
| P-trend | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | 0.07 | ||||||
| DASH | ||||||||||||
| Q1 (8–19) | 763 | 136,022 | 1.0 | 1.0 | 409 | 136,022 | 1.0 | 1.0 | 871 | 136,022 | 1.0 | 1.0 |
| Q2 (20–22) | 1221 | 217,734 | 0.90 (0.82, 0.98) | 0.90 (0.83, 0.99) | 680 | 217,734 | 0.91 (0.80, 1.03) | 0.95 (0.84, 1.08) | 1250 | 217,734 | 0.85 (0.78, 0.93) | 0.92 (0.84, 1.00) |
| Q3 (23–24) | 913 | 179,136 | 0.80 (0.73, 0.88) | 0.83 (0.76, 0.92) | 496 | 179,136 | 0.78 (0.68, 0.88) | 0.85 (0.75, 0.98) | 998 | 179,136 | 0.82 (0.75, 0.90) | 0.94 (0.85, 1.03) |
| Q4 (25–27) | 1101 | 233,318 | 0.75 (0.68, 0.82) | 0.80 (0.72, 0.88) | 618 | 233,318 | 0.74 (0.65, 0.84) | 0.85 (0.75, 0.97) | 1208 | 233,318 | 0.77 (0.71, 0.84) | 0.93 (0.85, 1.02) |
| Q5 (28–39) | 873 | 215,768 | 0.65 (0.59, 0.72) | 0.72 (0.65, 0.80) | 487 | 215,768 | 0.64 (0.56, 0.73) | 0.78 (0.68, 0.89) | 979 | 215,768 | 0.69 (0.63, 0.75) | 0.89 (0.82, 0.98) |
| P-trend | <0.001 | <0.000 | <0.001 | <0.001 | <0.001 | 0.07 | ||||||
| HDI | ||||||||||||
| Q1 (15.7–44.0) | 1108 | 190,181 | 1.0 | 1.0 | 579 | 190,181 | 1.0 | 1.0 | 1216 | 190,181 | 1.0 | 1.0 |
| Q2 (44.0–48.3) | 984 | 195,595 | 0.86 (0.79, 0.94) | 0.89 (0.82, 0.97) | 581 | 195,595 | 0.96 (0.86, 1.08) | 1.05 (0.93, 1.18) | 1088 | 195,595 | 0.87 (0.80, 0.94) | 0.96 (0.88, 1.04) |
| Q3 (48.4–52.1) | 982 | 196,971 | 0.83 (0.76, 0.91) | 0.89 (0.81, 0.97) | 544 | 196,971 | 0.84 (0.75, 0.95) | 0.93 (0.83, 1.05) | 994 | 196,971 | 0.76 (0.70, 0.83) | 0.87 (0.80, 0.95) |
| Q4 (52.2–56.3) | 963 | 197,935 | 0.81 (0.74, 0.88) | 0.88 (0.80, 0.96) | 520 | 197,935 | 0.79 (0.70, 0.89) | 0.89 (0.79, 1.01) | 1033 | 197,935 | 0.78 (0.71, 0.84) | 0.92 (0.84, 1.00) |
| Q5 (56.4–70.0) | 834 | 201,294 | 0.72 (0.66, 0.79) | 0.81 (0.74, 0.89) | 466 | 201,294 | 0.72 (0.63, 0.81) | 0.86 (0.76, 0.98) | 975 | 201,294 | 0.72 (0.66, 0.79) | 0.92 (0.84, 1.01) |
| P-trend | <0.001 | <0.001 | <0.001 | 0.003 | <0.001 | 0.40 | ||||||
1AHEI-2010, Alternative Healthy Eating Index–2010; aMED, alternate Mediterranean diet; CVD, cardiovascular disease; DASH, Dietary Approaches to Stop Hypertension; HDI, Healthy Diet Indicator; Q, quintile.
2Adjusted for age at interview (years), sex (men or women), and total energy intake (kilocalories per day).
3In addition to the basic model, we adjusted for dialect (Hokkien or Cantonese), level of education (none, primary, or secondary or above), smoking status (never; ex-smoker; current-smoker of <13 or ≥13 cigarettes/d), physical activity (<0.5 h of moderate and strenuous activity/wk, 0.5 to <4 h of moderate activity/wk or 0.5 to <2 h of strenuous activity/wk, or ≥4 h of moderate activity/wk or ≥2 h of strenuous activity/wk), sleep duration [short (≤6 h/d), normal (7–8 h/d), or long (≥9 h/d)], BMI (kg/m2), history of diabetes mellitus (yes or no), and history of hypertension (yes or no). The full model for the DASH and HDI score was further adjusted for alcohol consumption [never/hardly ever, mild (<0.5 servings/d), moderate (between 0.5 and 2.0 servings/d for men and between 0.5 and 1.5 servings/d for women), above moderate intake (≥2.0 servings/d for men and ≥1.5 servings/d for women)].