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 χ² tests were employed to test associations between categorical variables. Weighted linear regression was used to model the HEI-2015 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.