Spatial inequalities of retail food stores may determine availability of healthful food choices in a Brazilian metropolis
Abstract Objective: To examine the association between economic residential segregation and food environment. Design: Ecological. Food stores categorized according to the NOVA classification were geocoded, and absolute availability was calculated for each neighborhood. Segregation was measured using local Gi* statistic, a measure of the standard deviation (SD) between the economic composition of a neighborhood (the proportion of heads of households in neighborhoods earn monthly income of 0 to 3 minimum wages) and larger metropolitan area, weighted by the economic composition of surrounding neighborhoods. Segregation was categorized as high [most segregated], medium [integrated], and low [less segregated or integrated]. A proportional odds models were used to model the association between segregation and food environment. Setting: Belo Horizonte, Brazil. Participants: Food stores. Results: After adjustment for covariates, neighborhoods characterized by high economic segregation had fewer food stores overall compared to neighborhoods characterized by low segregation [OR=0.56;CI95%=0.45-0.69]. In addition, high segregated neighborhoods were 49% (OR=0.51;95%CI=0.42–0.61) and 45% (OR=0.55;95% CI=0.45–0.67) less likely to have a high number of food stores that predominantly marketed ultra-processed foods and mixed food stores, respectively, as compared to their counterparts. Conclusions: Economic segregation is associated with differences in the distribution of food stores. Both low and high segregation territories should be prioritized by public policies to ensure healthy and adequate nutrition as a right for all communities. The former must continue to be protected from access to unhealthy commercial food outlets while the latter must be the locus of actions that limit the availability of unhealthy commercial food store.