Distributions of Portfolio Diet Score (PDS) and adjusted differences in hazard ratio for primary outcome of CVD mortality using 13.97 as reference value (midpoint of the lowest tertile of PDS), in US adults: National Health and Nutrition Examination Survey Linked Mortality Files (1988–2019). Abbreviations: CI, confidence intervals; CVD, cardiovascular disease; HR, hazard ratio. Cox regression models were used to estimate the adjusted differences in HR of CVD and corresponding 95% CI. HRs were coded using restricted cubic spline (RCS) function with three knots located at the 5th, 50th, and 95th percentiles of the PDS distribution (reference value = 13.9, the mean PDS of tertile 1). Solid red line represents HR and dotted lines represent 95% CIs. Estimates were adjusted by age, sex, and race/ethnicity, educational attainment, smoking status, Poverty Income Ratio, marital status, physical activity, alcohol consumption, family history of CVD, self-reported cancer (other than skin), self-reported type-2 diabetes, self-reported hypertension, energy intake, and sodium. CVD mortality defined as deaths identified as Disease of heart (ICD codes: I00-I09, I11, I13, I20-I51) and Cerebrovascular disease (ICD codes I60-I69)
