Olstad, Dana LeeNejatinamini, SaraVictorino, CharlieKirkpatrick, Sharon IMinaker, Leia MMcLaren, Lindsay2022-03-072022-03-072021-09-03Olstad, D. L., Nejatinamini, S., Victorino, C., Kirkpatrick, S. I., Minaker, L. M., & McLaren, L. (2021). Socioeconomic inequities in diet quality among a nationally representative sample of adults living in Canada: an analysis of trends between 2004 and 2015. The American Journal of Clinical Nutrition, 114(5), 1814–1829. doi:10.1093/ajcn/nqab249http://hdl.handle.net/1880/114451https://doi.org/10.11575/PRISM/43774This is a pre-copyedited, author-produced version of an article accepted for publication in The American Journal of Clinical Nutrition following peer review. The version of record Dana Lee Olstad, Sara Nejatinamini, Charlie Victorino, Sharon I Kirkpatrick, Leia M Minaker, Lindsay McLaren, Socioeconomic inequities in diet quality among a nationally representative sample of adults living in Canada: an analysis of trends between 2004 and 2015, The American Journal of Clinical Nutrition, Volume 114, Issue 5, November 2021, Pages 1814–1829, https://doi.org/10.1093/ajcn/nqab249 is available online at: https://academic.oup.com/ajcn/article/114/5/1814/6363717 ..Background: Socioeconomic inequities in diet quality are stable or widening in the US, however these trends have not been well characterized in other nations. Moreover, purpose-developed indices of inequities that can provide a more comprehensive and precise perspective of trends in absolute and relative dietary gaps and gradients using multiple indicators of socioeconomic position have not yet been used, and can inform strategies to narrow dietary inequities. Objective: We quantified nationally representative trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to three indicators of socioeconomic position among adults in Canada. Design: Adults (≥18 years) who participated in the nationally representative, cross-sectional Canadian Community Health Survey-Nutrition in 2004 (n=20,880) or 2015 (n=13,970) were included. Socioeconomic position was classified using household income (quintiles), education (five categories) and neighborhood deprivation (quintiles). Dietary intake data from 24-hour recalls were used to derive Healthy Eating Index-2015 (HEI-2015) scores. Dietary inequities were quantified using absolute and relative gaps (between most and least disadvantaged), and absolute (Slope Index of Inequality) and relative gradients (Relative Index of Inequality). Overall and sex-stratified multivariable linear regression and generalized linear models examined trends in HEI-2015 scores between 2004 and 2015. Results: Mean HEI-2015 scores improved from 55.3 to 59.0 (maximum 100); however, these trends were not consistently equitable. While inequities in HEI-2015 scores were stable in the total population and in females, the absolute gap [1.60 (95% CI 0.09, 3.10) to 4.27 (2.20, 6.34)] and gradient [SII=2.09 (0.45, 3.73) to SII=4.84 (2.49, 7.20)] in HEI-2015 scores for household income, and the absolute gradient for education [SII=8.06 (6.41, 9.71) to SII=10.52 (8.73, 12.31)], increased in males. Conclusions: Absolute and relative gaps and gradients in overall diet quality remained stable or widened between 2004 and 2015 among adults in Canada.eng© The Author(s) 2021diet qualitydietary inequitiesHealthy Eating Indexrelative inequitiesabsolute inequitiesadultsjournal articlehttp://dx.doi.org/10.1093/ajcn/nqab249