Abstract P422: Diminished Returns: Racial/Ethnic Differences in Diet Quality Vary by Education Level

Abstract

Introduction: Poor diet is a major modifiable risk factor for cardiovascular disease. Educational attainment is highly correlated with healthy dietary behavior; as education level increases, diet quality also increases. Nevertheless, a recent study reported that Black adults with a high education level consume lower amounts of healthy foods (e.g., fruits, vegetables, whole grains) compared to White adults with a high education level. These findings are concerning because they suggest that certain individual or structural factors may produce diminished returns on educational investment among Black-identifying people. The literature on this topic is scarce. To address this gap, this study examined racial/ethnic differences in diet quality by education level among U.S. adults. Hypothesis: Black adults with ≥ bachelor’s degree will have lower diet quality than White adults with the same education level. Methods: We analyzed cross-sectional data on 19,591 adults (age ≥ 20) who participated in the National Health & Nutrition Examination Survey from 2011-2018. We calculated Healthy Eating Index (HEI)-2015 total scores using the participant’s 24-hour recall data. HEI-2015 (scale: 0-100) reflects how well an individual’s food and beverage intake aligns with the 2015-2020 Dietary Guidelines for Americans . We ran stratified linear regression models to identify racial/ethnic differences in HEI-2015 total score within each category of educational attainment: < high school, high school or equivalent, some college/associate’s degree, ≥ bachelor’s degree. All models were adjusted for age, sex, marital status, poverty level, and household size. Results: Regression models revealed that Asian adults, on average, had significantly higher HEI-2015 total scores compared to White adults at every education level (p<0.0001 in all models). Hispanic adults had significantly higher scores than White adults in every educational category except ≥ bachelor’s degree where there was no difference. There was no difference in HEI-2015 total score between Black and White adults at every education level except ≥ bachelor’s degree. Black adults with a bachelor’s degree, on average, had a lower HEI-2015 total score (β = -1.69; SE: 0.79; p=0.03) compared to White adults with the same education level. Additional sex-specific analyses revealed that this disparity existed mainly between Black and White women with ≥ bachelor’s degree (β = -2.26; SE: 1.11; p=0.04). Conclusion: This study found that racial/ethnic differences in diet quality do vary by education level. As hypothesized, there is a Black-White disparity in diet quality among adults with higher education levels. Additional research is need to explore the individual and structural factors associated with this disparity.