(OR17-02-23) Does Socioeconomic Deprivation Modify the Association Between Healthy Eating Index-2015 and Mortality in the NIH-AARP Diet and Health Study?

Objectives: We investigated the modifying effect of neighborhood deprivation on diet quality and mortality risks in US older adults.

Methods: Healthy Eating Index-2015 (HEI-2015) scores assessed alignment with the Dietary Guidelines for Americans 2015-2020 and were calculated using food questionnaire data in 544,837 (321,756 men and 223,081 women) NIH-AARP Diet and Health Study participants aged 51-70 years at baseline (1995-96). A neighborhood socioeconomic deprivation index was developed using principal component analysis, based on census tract data. Multivariable-adjusted Cox-proportional hazard regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) by HEI-2015 quintile and mortality risks, stratified by median neighborhood socioeconomic deprivation index scores [low (< median) vs. high (≥median)]. We examined deaths from all-cause, cancer, heart, neurological, respiratory, kidney, liver, autoimmune diseases, diabetes mellitus, accidents and suicides, and other causes.

Results: During follow-up through 2019 (median 22.8 years), 282,073 deaths occurred. Overall, highest (Q5), vs. lowest (Q1), HEI-2015 scores were associated with lower risk of all-cause mortality (HR: 0.86; 95% CI: 0.85-0.87). Neighborhood deprivation significantly modified associations between HEI-2015 and all-cause mortality with stronger protective associations among those with low vs. high deprivation: HRs (95% CIs) [0.84 (0.82-0.85)] and [0.88 (0.87-0.90)], respectively (P-interaction = 0.002). Similarly for cause-specific mortalities, those in the low deprivation strata had stronger protective associations with increasing HEI-2015 scores than in high deprivation. The strongest associations were for HEI-2015 and chronic kidney disease mortality, with 33% vs. 16% reduced risks by low and high deprivation, respectively. Findings were similar in sex-stratified analyses.

Conclusions: Higher diet quality was more protective (16 vs. 12%) for all-cause mortality among participants living in the least deprived neighborhoods, compared to those living in most deprived neighborhoods. Results highlight potential disparities in the protective effects of US dietary guidelines by neighborhood deprivation.

Funding Sources: Intramural Research Program, DCEG, NCI, NIH