(P21-21-26) Socioeconomic Deprivation and Diet Quality Among Adults With Type 2 Diabetes and Hypertension: Data From the DASH4D Trial

Sunday, July 26, 2026

9:30 AM - 10:30 AM ET

Location: Poster Board E-53

Presenting Author(s)

Annalisa Lim, MSPH

Graduate Student
Johns Hopkins Bloomberg School of Public Health
San Diego, California, United States

Co-Author(s)

CM

Christine Mitchell

Johns Hopkins University, United States
Casey M. Rebholz, PhD, MPH, MNSP, MS

Associate Professor
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States
SO

Susan Oh, MS, MPH

Johns Hopkins Institute for Clinical and Translational Research, United States
LA

Lawrence J. Appel, MD, MPH

Professor
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States
SP

Scott Pilla

Johns Hopkins University, United States
HY

Hsin-Chieh Yeh, PhD

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States

Disclosure(s):

Annalisa Lim, MSPH: No relevant financial relationship(s) with ineligible companies to disclose.

Casey M. Rebholz, PhD, MPH, MNSP, MS: American Diabetes Association: Independent Contractor (including contracted research) (Ongoing)

Objectives: To compare levels of adherence to the 2020-2025 Dietary Guidelines for Americans by neighborhood socioeconomic deprivation among adults with type 2 diabetes and hypertension.

Methods: This cross-sectional analysis included adults from the Baltimore metropolitan area who were screened for eligibility for the DASH4D feeding trial. Neighborhood socioeconomic deprivation was measured by national-level Area Deprivation Index (ADI; percentile score 1-100; higher scores indicate greater deprivation) based on census block data. Diet quality was assessed from the average of two 24-hour dietary recalls and scored using the Healthy Eating Index-2020 (HEI-2020; scored 0-100; higher scores indicate better alignment with the Dietary Guidelines) and its component scores (13 components, measuring compliance with different aspects of the Dietary Guidelines).

Results: Participants (n = 231) were majority African American (83%) and female (62%); mean age was 65.7 years (SD = 9.5); 20% reported high school education or less; and 15% reported an annual household income < $30,000. Mean HEI score was 53.7 (SD = 13.2); mean ADI was 46.9 (SD = 22.3). There was a progressive, inverse relationship between ADI percentiles and HEI (r = -0.18; p< 0.01 for trend). Compared to individuals in the lowest ADI quintile (1^st-20^th percentile), mean HEI differences (95% confidence intervals) were -3.8 (-9.5 to 2.0), -7.1 (-12 to -1.9), and -7.3 (-13 to -1.7) for the 21^st-40^th percentile, 41^st-60^thpercentile, and 61^st-100^th percentile groups, respectively. Higher ADI percentiles were significantly associated with lower HEI component scores for greens and beans (p < 0.01) and seafood and plant protein (p < 0.01). After adjusting for age, sex, race, BMI, blood pressure, and HbA1c, associations remained significant for both total HEI and component scores.

Conclusions: In this study of persons with type 2 diabetes and hypertension, greater neighborhood socioeconomic deprivation was associated with lower diet quality. These findings underscore the need for additional nutrition interventions in disadvantaged neighborhoods.

Funding Sources: Sheikh Khalifa Stroke Institute at Johns Hopkins