Healthy Eating Index Scores Differ by Race/Ethnicity but Not Hypertension Awareness Status among US Adults with Hypertension: Findings from the 2011-2018 National Health and Nutrition Examination Survey

Background Little is known about whether or not diet quality is associated with race/ethnicity as well as hypertension awareness status among adults with hypertension. Objective The aim of this study was to examine associations between diet quality and race/ethnicity as well as hypertension awareness. Design Analysis of the 2011-2018 National Health and Nutrition Examination Survey, a cross-sectional survey representative of the US population. Participants/setting A total of 6,483 participants with hypertension who were at least 18 years old and had dietary recall data were included. Main outcome measures Diet quality was assessed by Healthy Eating Index 2015 (HEI-2015). Statistical analysis performed Weighted chi(2) tests were employed to test associations between categorical variables. Weighted linear regression was used to model the HEI2015 score by various covariates. Results Among the 6,483 participants with hypertension included in this study, the average HEI-2015 total score was 54.0 out of the best possible score of 100. In unadjusted analysis, the HEI-2015 total score was significantly different by race/ethnicity (P < 0.01), being 60.9 for non-Hispanic Asian participants, 54.4 for Hispanic, 53.8 for non-Hispanic White, and 52.7 for non-Hispanic Black participants. The HEI-2015 component scores were statistically different by race/ethnicity for all the 13 components (all P values < 0.01). In adjusted analysis, race/ethnicity was significantly associated with the total HEI-2015 score (P < 0.0001), but hypertension awareness status was not (P = 0.99), after controlling for age, sex, body mass index, marital status, education level, income level, and insurance status. Conclusions There were significant racial/ethnic differences in HEI-2015 scores among participants with hypertension. Hypertension awareness status was not associated with HEI-2015 scores. Further study is needed to identify reasons why there was an association between HEI-2015 scores and race/ethnicity, and a lack of association with hypertension awareness.