Abstract
Objective grocery transactions may reflect diet, but it is unclear whether the diet quality of grocery purchases mirrors geographic and racial/ethnic disparities in diet-related diseases. This cross-sectional analysis of 3961 households in the nationally representative Food Acquisition and Purchase Survey evaluated geographic and racial/ethnic disparities in grocery purchase quality. Respondents self-reported demographics and recorded purchases over 7 days; the Healthy Eating Index (HEI) 2015 assessed diet quality. Survey-weighted multivariable-adjusted regression determined whether there were geographic and racial/ethnic differences in HEI-15 scores. Respondents were, on average, 50.6 years, non-Hispanic white (NHW) (70.3%), female (70.2%), and had attended some college (57.8%). HEI-15 scores differed across geographic region (p < 0.05), with the highest scores in the West (57.0 ± 0.8) and lowest scores in the South (53.1 ± 0.8), and there was effect modification by race/ethnicity (p-interaction = 0.02). Regionally, there were diet disparities among NHW and non-Hispanic black (NHB) households; NHWs in the South had HEI-15 scores 3.2 points lower than NHWs in the West (p = 0.003). Southern NHB households had HEI-15 scores 8.1 points lower than Western NHB households (p = 0.013). Racial/ethnic disparities in total HEI-15 by region existed in the Midwest and South, where Hispanic households in the Midwest and South had significantly lower diet quality than NHW households. Heterogeneous disparities in the diet quality of grocery purchases by region and race/ethnicity necessitate tailored approaches to reduce diet-related disease.
Highlights
The Behavioral Risk Factor Surveillance System (BRFSS) has documented increasing geographic and racial/ethnic disparities in overweight, obesity, and type 2 diabetes prevalence [1], which contributes to cardiovascular morbidity and mortality in the US
Racial/ethnic disparities in total Healthy Eating Index (HEI)-15 by region existed in the Midwest and South, where Hispanic households in the Midwest and South had significantly lower diet quality than non-Hispanic white (NHW) households
The primary objective of this study was to evaluate whether the overall diet quality of household grocery purchases varied by geographic region and race/ethnicity in a manner similar to geographic disparities in obesity prevalence observed by region and race/ethnicity in the BRFSS
Summary
The Behavioral Risk Factor Surveillance System (BRFSS) has documented increasing geographic and racial/ethnic disparities in overweight, obesity, and type 2 diabetes prevalence [1], which contributes to cardiovascular morbidity and mortality in the US. Ingrained racial/ethnic disparities in diet quality [8,9,10] relatively resistant to intervention efforts necessitates greater contextualization of the drivers of food choice across high-risk groups, many of which are environmental [11]. This is true given the variability observed across race/ethnicity in whether dietary adequacy and/or moderation recommendations are met [12], spurring further investigation about how differences in purchasing patterns and food preparation may contribute to observed differences [13]
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