Did national folic acid fortification reduce socioeconomic and racial disparities in folate status in the US?
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.
Dowd
Jennifer Beam
JB
Center for Social Epidemiology & Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA.
Aiello
Allison E
AE
D000328:Adult; D001741:Black or African American; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D004912:Erythrocytes / Q000737:chemistry*; D005006:Ethnicity; D005492:Folic Acid / Q000032:analysis* / Q000097:blood; D005494:Folic Acid Deficiency / Q000097:blood / Q000517:prevention & control*; D005527:Food, Fortified; D006304:Health Status; D006630:Hispanic or Latino; D006801:Humans; D009749:Nutrition Surveys; D012923:Social Class; D014481:United States; D014803:Vitamin B Complex / Q000008:administration & dosage*; D044465:White People
D014803:Vitamin B Complex; D005492:Folic Acid