Abstract
Background: Even though the existence of inequalities in fruit and vegetable consumption has been well established, it is not clear how it is patterned across intersections of multiple social positions and identities. This study aims to investigate disparities in fruit and vegetable intake between groups at the intersection of education and gender in northern Sweden, and to estimate the discriminatory accuracy of the intersectional groups.Methods: Cross-sectional data from the 2018 Health on Equal Terms survey conducted in four regions in northern Sweden was used (N=21,853). Four intersectional groups were created: high and low educated men, and high and low educated women. Prevalence differences corresponding to joint, referent, and excess intersectional inequalities, were estimated using linear binomial regression for three binary outcome variables: inadequate fruit and vegetable intake combined, inadequate fruit intake, and inadequate vegetable intake. The analysis was adjusted for potential confounders. The discriminatory accuracy of the intersectional groups was estimated by the area under the receiver operating characteristic curve.Results: Low educated men had the highest prevalence of inadequate intake of fruits and vegetables combined (81.4%), fruits (53.5%), and vegetables (54.2%), while high educated women had the lowest (47.7%, 28.6%, and 19.2% respectively). The joint disparities between high educated women and low educated men were both significant and substantial for all outcome variables (34.6 pp, 28.7pp, and 34.9pp respectively, adjusted). They were mostly explained by the two referent disparities for gender and education – the part of the joint disparity explained by differences in gender and education, respectively. An inconsistent direction, magnitude, and significance between outcomes was observed for the excess intersectional disparity - the part of the joint disparity not explained by either referent disparity (-5.5pp, 0.1pp, and 3.9pp respectively, adjusted). The discriminatory accuracy of the intersectional groups was moderate (0.67, 0.64, and 0.66 respectively).Conclusion: An intersectional approach can provide a more detailed view of inequalities in fruit and vegetable consumption between groups combining several social positions. The moderate discriminatory accuracy observed here suggests that interventions and policies aiming to reduce diet inequalities should not solely be targeted at certain groups, but also be universal.