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IJE Advance Access originally published online on May 2, 2008
International Journal of Epidemiology 2008 37(5):1059-1066; doi:10.1093/ije/dyn066
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2008; all rights reserved.

Did national folic acid fortification reduce socioeconomic and racial disparities in folate status in the US?

Jennifer Beam Dowd* and Allison E Aiello

Center for Social Epidemiology & Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA.

* Corresponding author. Robert Wood Johnson Health and Society Scholar, Center for Social Epidemiology & Population Health, 3634 SPH Tower, 109 Observatory, Ann Arbor, MI 48109-2029, USA. E-mail: jenndowd{at}umich.edu


  Abstract

Background The purpose of this study is to determine the impact of the 1998 US Food and Drug Administration folic acid fortification policy on disparities in folate status in the United States.

Methods We use repeated cross-sectional data from the U.S. National Health and Nutrition Examination Surveys (NHANES), a nationally representative sample of over 14 000 participants ages 25 and older. We calculate pre-fortification (1991–94) and post-fortification (1999–2002) absolute differences and relative prevalence ratios of low red blood cell (RBC) folate status (<362.6 nmol), by race/ethnicity and income quartile. We also estimate kernel density plots and relative and absolute concentration curves pre- and post-fortification.

Results The excess prevalence of low RBC folate status associated with the lowest income quartile and black race declined by 67% and 48%, respectively, following fortification. Despite these absolute gains, the relative ratio of low folate status increased after fortification for the lowest compared with the highest income groups (from 1.27 to 2.08) and among whites compared with blacks (from 1.64 to 3.75).

Conclusions The effects of the fortification policy highlight the importance of distinguishing absolute from relative differences when evaluating interventions to reduce health disparities. Targeting of high risk populations is likely needed to eliminate remaining folate disparities.

Keywords Folate, folic acid, fortification, socioeconomic factors, ethnic groups

Accepted 10 March 2008


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