Abstract P265: Macrosocial Disparity, Diet, and Cardiovascular Mortality in Global Populations Undergoing Transition
Background: Economic and social disparities are linked to poor health outcomes in diverse countries worldwide. Differences in diet may mediate many of these effects, yet to-date, the impact of social, economic, and demographic inequality on the quality and diversity of diet has not been examined in a comparable manner globally.
Objective: To comparably quantify the relationships of macroeconomic indicators of disparity with diet quality in 84 countries worldwide, and to assess their associations with CVD mortality.
Methods: Data on country-specific per-capita GDP, urbanization, income inequality (income Gini coefficient and share of income held by top 1%), education, and educational inequality (educational Gini); on dietary quality and diversity; and on CVD mortality rates were obtained from our Global Dietary Database and other sources (Figure). Relationships between income inequality, diet quality, and CVD mortality were examined through multivariate regression controlling for country-level per-capita GDP, including country-level fixed effects, as well as through non-parametric Loess regression. Analyses were performed separately for 1990, 2010, and for the percent change between 1990 and 2010 for each variable.
Results: From 1990-2010 income inequality increased by >5% in 51 of 84 countries and decreased by > 5% in 15/84 countries. Of countries with increasing income inequality, 61% had worsening scores for unhealthy diet; of those with decreasing income inequality, only 27% had worsening unhealthy diet scores. CVD mortality increased in 43% of countries with increasing income inequality, primarily in Eastern Europe/Asia; while it declined in ½ of countries with declining income inequality (Figure). Results for educational inequality and urbanization are in progress.
Conclusions: This first cross-country analysis of macrosocial disparities, diet quality and CVD mortality highlights regional heterogeneity and time variance the impacts of these inequities on diet and subsequent risk of CVD.
Author Disclosures: G.M. Singh: None. K. Morrish: None. W. Masters: None. D. Mozaffarian: E. Honoraria; Modest; Bunge, Haas. G. Consultant/Advisory Board; Modest; amarin, Astra Zeneca, nutrition impact, Boston heart diagnostics, GOED, life sciences research organization.
- © 2016 by American Heart Association, Inc.