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Health equity

Who in the US has the poorest diet scores?

McCullough ML, Chantaprasopsuk S, Islami F, et al. · JAMA network open · 2022

Open access · cc by · source: Europe PMC

Among 155,331 CPS-3 adults, poor ACS diet quality was independently higher in Black (+16%) and rural (+61%) participants and in food deserts (+17%), while Hispanic (−16%) and Asian/NHPI (−33%) groups had lower risk.

Study at a glance

Design
Cross-sectional — Cancer Prevention Study-3 adults; ACS 2020 diet score poorest quartile vs race/ethnicity, education, income, rurality, and USDA food-desert status
N
N=155331 · 155,331 adults (123,115 women, 79.3%); mean age 52 years; enrolled 2006–2013, FFQ 2015–2017
Population
US adults in CPS-3 from 35 states, D.C., and Puerto Rico with a validated food-frequency questionnaire
Outcome
Poor diet quality (lowest quartile of ACS 2020 recommendation concordance) and component foods

Structured fields used in claim comparison tables when every cited study has a complete layer.

Key findings

All key exposures associated with poor diet. Black vs White +16% risk; Hispanic −16%; Asian/NHPI −33%. Rural +61%; food desert +17%. Income and education effects differed by race/ethnicity (interaction p=0.01 and <0.001).

Methodology

Linked CPS-3 demographics and geocoded rurality/food-desert status to a 2015–2017 FFQ scored against 2020 ACS cancer-prevention diet recommendations (vegetables, fruit, whole grains, red/processed meat, ultraprocessed foods, sugary drinks).

Limitations

Cross-sectional FFQ cannot prove that moving out of a food desert improves diet; CPS-3 is volunteer-heavy and 88.9% White, so absolute US disparities are underestimated.

How this study connects

Role on claims

Each row is a claim on a concept or method page where this paper supports, challenges, or qualifies the statement. Roles are hand-checked — not a model guess.

  • SupportsHealth Equityconcept

    In US adults, poor diet quality tracks race, rurality, and food-desert residence independently.

    Among 155,331 CPS-3 adults, poor ACS diet quality was independently higher in Black (+16%) and rural (+61%) participants and in food deserts (+17%), while Hispanic (−16%) and Asian/NHPI (−33%) groups had lower risk; income and education effects differed by race/ethnicity.

    Evidence for the claim as stated.

  • QualifiesHealth Equityconcept

    Outdoor PM and NO2 linked to worse cognition more strongly in older Korean women than men.

    In 1,484 Koreans aged ≥55, women had more cognitive impairment (10.27% vs 5.62%). Adjusted ORs for women vs men were 1.01 per PM10 and 1.03 per coarse PM; NO2 ORs were 1.02 in metros and 1.12 outside metros.

    Scope note — US diet-quality geography ≠ Korean outdoor PM/NO2 × MMSE

    Limits the claim's scope: a different population, assay, or outcome.

  • SupportsHealth Equityconcept

    eHealth usage among Internet users, a homeless–housed disease cliff, US diet-quality geography, and Korean PM×gender MMSE are related equity problems with different exposures and endpoints.

    Evidence for the claim as stated.

Open questions

Tensions this paper is part of

From concept pages' “where studies disagree.” Disagreement means the same question; scope means different assays, populations, or outcomes.

History

When this study was placed

Dated entries from the concept change log — when this paper was added or removed as support, challenge, or qualifier on a claim.

  1. 2026-09-18

    Placed as supporting evidence on Health Equity

    Among 155,331 CPS-3 adults, poor ACS diet quality was independently higher in Black (+16%) and rural (+61%) participants and in food deserts (+17%), while Hispanic (−16%) and Asian/NHPI (−33%) groups had lower risk; income and education effects differed by race/ethnicity.

  2. 2026-09-18

    Placed as a scope qualifier on Health Equity

    In 1,484 Koreans aged ≥55, women had more cognitive impairment (10.27% vs 5.62%). Adjusted ORs for women vs men were 1.01 per PM10 and 1.03 per coarse PM; NO2 ORs were 1.02 in metros and 1.12 outside metros.

  3. 2026-09-18

    Placed as supporting evidence on Health Equity

    eHealth usage among Internet users, a homeless–housed disease cliff, US diet-quality geography, and Korean PM×gender MMSE are related equity problems with different exposures and endpoints.

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