Table 2. Socioeconomic and Geographic Factors Associated With Poor Diet Quality Overall and Poor Diet Quality Component Scoresa .
| Factor | Outcome, OR (95% CI) | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Poor overall diet quality | Poor individual diet component scoreb | ||||||||
| Model 1c | Model 2d | Model 3e | Vegetables | Fruits | Whole grains | RP meats | SSB | HPF/RG | |
| Race and ethnicity | |||||||||
| American Indian or Alaska Native | 1.18 (1.05-1.33) | 1.04 (0.92-1.18) | 0.96 (0.85-1.09) | 0.88 (0.76-1.03) | 1.12 (0.98-1.29) | 0.99 (0.87-1.13) | 1.18 (1.04-1.34) | 1.21 (1.07-1.38) | 0.78 (0.69-0.89) |
| Asian, Native Hawaiian, or Pacific Islander | 0.54 (0.49-0.60) | 0.67 (0.60-0.74) | 0.69 (0.62-0.77) | 0.56 (0.50-0.64) | 0.77 (0.69-0.86) | 1.19 (1.08-1.30) | 0.66 (0.60-0.74) | 0.67 (0.59-0.75) | 0.83 (0.76-0.91) |
| Black | 1.14 (1.06-1.23) | 1.16 (1.08-1.25) | 0.96 (0.89-1.03) | 1.10 (1.01-1.20) | 1.09 (1.00-1.18) | 0.92 (0.85-1.00) | 1.03 (0.95-1.12) | 2.30 (2.14-2.48) | 0.58 (0.53-0.63) |
| Hispanic | 0.87 (0.82-0.92) | 0.84 (0.79-0.88) | 0.81 (0.76-0.85) | 0.97 (0.91-1.03) | 0.87 (0.82-0.93) | 0.91 (0.86-0.97) | 0.92 (0.87-0.98) | 1.00 (0.94-1.06) | 0.74 (0.70-0.79) |
| White | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Otherf | 0.71 (0.62-0.82) | 0.71 (0.61-0.81) | 0.66 (0.57-0.76) | 0.72 (0.61-0.85) | 0.84 (0.72-0.99) | 1.03 (0.89-1.18) | 0.76 (0.66-0.88) | 1.03 (0.89-1.18) | 0.55 (0.48-0.64) |
| Income, $ | |||||||||
| <25 000 | 1.25 (1.17-1.33) | 1.08 (1.02-1.15) | 1.01 (0.94-1.07) | 1.27 (1.18-1.37) | 1.26 (1.17-1.35) | 1.06 (0.99-1.14) | 0.88 (0.83-0.95) | 1.28 (1.19-1.36) | 0.93 (0.87-0.99) |
| 25 000 to <50 000 | 1.20 (1.15-1.26) | 1.10 (1.05-1.15) | 1.06 (1.02-1.11) | 1.14 (1.08-1.20) | 1.14 (1.09-1.20) | 1.03 (0.99-1.08) | 1.01 (0.96-1.05) | 1.17 (1.12-1.23) | 1.02 (0.98-1.07) |
| 50 000 to <75 000 | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| 75 000 to <100 000 | 0.89 (0.85-0.92) | 0.95 (0.92-0.99) | 0.98 (0.94-1.02) | 0.91 (0.87-0.96) | 0.91 (0.87-0.95) | 1.02 (0.98-1.06) | 1.00 (0.96-1.04) | 0.85 (0.81-0.88) | 0.94 (0.90-0.98) |
| 100 000 to <125 000 | 0.78 (0.75-0.81) | 0.89 (0.86-0.93) | 0.96 (0.92-1.00) | 0.86 (0.82-0.90) | 0.85 (0.81-0.89) | 0.98 (0.94-1.02) | 1.00 (0.96-1.05) | 0.77 (0.73-0.80) | 0.94 (0.90-0.97) |
| 125 000 to <150 000 | 0.69 (0.65-0.72) | 0.83 (0.79-0.87) | 0.92 (0.87-0.97) | 0.74 (0.70-0.78) | 0.81 (0.77-0.86) | 1.03 (0.98-1.08) | 0.97 (0.92-1.02) | 0.69 (0.65-0.73) | 0.89 (0.85-0.93) |
| ≥150 000 | 0.54 (0.52-0.56) | 0.71 (0.68-0.74) | 0.84 (0.80-0.87) | 0.69 (0.65-0.72) | 0.77 (0.73-0.80) | 1.03 (0.99-1.07) | 0.86 (0.83-0.90) | 0.55 (0.53-0.58) | 0.78 (0.75-0.81) |
| Educational level | |||||||||
| ≤High school | 2.35 (2.25-2.46) | 1.99 (1.90-2.09) | 1.83 (1.75-1.92) | 1.50 (1.42-1.58) | 1.63 (1.55-1.72) | 1.63 (1.55-1.71) | 1.43 (1.36-1.50) | 1.66 (1.58-1.75) | 1.29 (1.23-1.35) |
| Some college or 2-y degree | 1.57 (1.53-1.62) | 1.42 (1.38-1.47) | 1.32 (1.28-1.36) | 1.11 (1.07-1.15) | 1.23 (1.19-1.28) | 1.33 (1.29-1.38) | 1.33 (1.29-1.37) | 1.36 (1.32-1.41) | 1.08 (1.05-1.12) |
| College graduate | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Graduate degree | 0.72 (0.70-0.74) | 0.76 (0.73-0.78) | 0.77 (0.75-0.80) | 0.84 (0.81-0.87) | 0.84 (0.81-0.88) | 0.88 (0.85-0.91) | 0.76 (0.74-0.79) | 0.82 (0.79-0.85) | 0.97 (0.94-1.00) |
| RUCA | |||||||||
| Metropolitan | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Micropolitan | 1.76 (1.69-1.83) | 1.50 (1.44-1.56) | 1.43 (1.38-1.49) | 1.21 (1.15-1.26) | 1.18 (1.12-1.23) | 1.01 (0.97-1.06) | 1.46 (1.40-1.52) | 1.37 (1.31-1.43) | 1.20 (1.15-1.24) |
| Small town | 1.89 (1.77-2.01) | 1.54 (1.44-1.64) | 1.48 (1.38-1.59) | 1.22 (1.12-1.32) | 1.14 (1.05-1.23) | 1.03 (0.95-1.11) | 1.64 (1.53-1.76) | 1.28 (1.19-1.38) | 1.12 (1.05-1.20) |
| Rural | 1.99 (1.83-2.16) | 1.61 (1.48-1.75) | 1.55 (1.42-1.69) | 1.34 (1.21-1.48) | 1.19 (1.07-1.32) | 1.00 (0.91-1.10) | 1.80 (1.65-1.96) | 1.19 (1.08-1.32) | 1.12 (1.02-1.22) |
| Residing in a food desert | |||||||||
| No | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] |
| Yes | 1.43 (1.37-1.50) | 1.17 (1.12-1.22) | 1.12 (1.07-1.17) | 1.05 (0.99-1.10) | 1.08 (1.03-1.14) | 1.08 (1.03-1.14) | 1.14 (1.09-1.20) | 1.17 (1.11-1.22) | 0.99 (0.95-1.04) |
Abbreviations: HPF/RG, highly processed foods and refined grains; RP, red and processed; RUCA, rural-urban commuting area; SSB, sugar sweetened beverages.
Total scores range from 0 to 12, with higher score indicating better diet quality. Poor overall diet quality is defined as a diet score in the bottom sex-specific quartile (men: 0 to <4.50; women: 0 to <4.75); poor component scores have a score of 0 (lowest sex-specific quartile) for servings per day (vegetables: men, ≤2.1; women, ≤2.4; fruit: men, ≤0.9; women, ≤1.1; whole grains: men, ≤0.7; women, ≤0.7; RP meat: men, >1.5; women, >1.2; HPF/RG: men, >39% kcal; women, >40% kcal). Poor SSB scores are defined as 3 or more servings per week in men and in women. Poor SSB scores were liberalized from the 7 or more servings per week cut point for the overall score (eTable 1 in the Supplement) to increase the percentage exposed to 26% for men and 16% for women, comparable to proportions for other components.
Model 2 (adjusted for age, sex, energy intake, and mutually adjusted for all main exposures) was used for the analyses by diet score components. Poor component scores represented less vegetables, fruits, whole grains and more RP meats, SSBs, and HPF/RG.
Adjusted for age, sex, and energy intake.
Mutually adjusted for all main exposures, age, sex, and energy intake.
Mutually adjusted for all main exposures, age, sex, energy intake, and additional covariates, including body mass index (calculated as weight in kilograms divided by height in meters squared and categorized as <25, 25 to <30, 30 to <35, ≥35, and missing), alcohol intake (none, >0 to 1 drink per day, >1-2 drinks per day, >2 drinks per day, and missing), and a comorbidity score (includes diabetes; high blood pressure; high cholesterol; cancer; myocardial infarction; heart bypass surgery, angioplasty, or stent; stroke; and emphysema, chronic bronchitis, or chronic obstructive pulmonary disease; 1 point for each; modeled as 0, 1, and ≥2).
Includes individuals who identified as more than 1 minority race or ethnicity.