摘要：Objectives. We evaluated the spatial accessibility of large “chain” supermarkets in relation to neighborhood racial composition and poverty. Methods. We used a geographic information system to measure Manhattan block distance to the nearest supermarket for 869 neighborhoods (census tracts) in metropolitan Detroit. We constructed moving average spatial regression models to adjust for spatial autocorrelation and to test for the effect of modification of percentage African American and percentage poor on distance to the nearest supermarket. Results. Distance to the nearest supermarket was similar among the least impoverished neighborhoods, regardless of racial composition. Among the most impoverished neighborhoods, however, neighborhoods in which African Americans resided were, on average, 1.1 miles further from the nearest supermarket than were White neighborhoods. Conclusions. Racial residential segregation disproportionately places African Americans in more-impoverished neighborhoods in Detroit and consequently reduces access to supermarkets. However, supermarkets have opened or remained open close to middle-income neighborhoods that have transitioned from White to African American. Development of economically disadvantaged African American neighborhoods is critical to effectively prevent diet-related diseases among this population. Four of the 10 leading causes of death in the United States are chronic diseases for which diet is a major risk factor. 1 Racial disparities in the burden of these chronic, diet-related diseases are well documented, with African Americans often having the highest morbidity and mortality. 2– 5 Because health risks and resources are spatially and socially structured and African Americans disproportionately live in economically disadvantaged neighborhoods, increased attention has been focused on how residential environments shape health and contribute to racial disparities in health. 6– 9 An extensive body of literature now associates residence in economically disadvantaged neighborhoods, after control for individual socioeconomic status, with a variety of adverse diet-related health outcomes. 10– 12 Despite numerous research efforts that have examined neighborhood variations in health, relatively little is known about the mechanisms by which neighborhood environments affect health. 13– 15 One hypothesis is that economically and socially disadvantaged neighborhoods have inadequate access to healthy foods, thus negatively affecting dietary quality and health. Although the presence of supermarkets may not always be beneficial for neighborhood residents (e.g., if supermarkets displace smaller stores with owners who had positively contributed to and invested in the neighborhood), such large stores can be neighborhood health resources providing generally better availability and selection, higher quality, and lower cost of foods compared with smaller food stores. 16 These food resource factors influence dietary patterns. 17– 24 Previous studies have found that fewer supermarkets are located in African American neighborhoods compared with White neighborhoods 25, 26 and are located in economically disadvantaged neighborhoods compared with affluent neighborhoods. 16, 26– 29 Other studies have found no differences in the accessibility of supermarkets according to racial or socioeconomic characteristics of neighborhoods. 30– 32 This discrepancy could reflect either differences in the definition of supermarkets or true variability in results across time and place that may be caused by differences in the degree of racial or economic segregation. Lower purchasing power is an often-cited but disputed explanation for the relative scarcity of supermarkets in economically disadvantaged neighborhoods. 33– 35 Analysis of the role of race without regard to poverty and of poverty without regard to race offers an incomplete picture of the potential importance of these factors in shaping the spatial accessibility of supermarkets. Understanding these relationships is critical for informing intervention and policy efforts. Such an understanding is particularly important, given the roles of racial residential segregation and economic restructuring in concentrating poverty in African American neighborhoods of older industrial cities of the Northeast and Upper Midwest. 36– 40 Therefore, we sought to determine whether supermarkets are located at farther distances from the center of African American neighborhoods compared with White neighborhoods regardless of neighborhood economic conditions or if racial disparities in supermarket accessibility occur only in higher-poverty contexts.
