Geographic differences in the dietary quality of food purchases among participants in the nationally representative food acquisition and purchase survey (FoodAPS)

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.