A new analysis by researchers at the University of California, Riverside, has found an association between the presence of dollar stores and higher rates of obesity, high blood pressure, cholesterol and type 2 diabetes across major urban areas in the continental United States.
Research methods and scope
The study, published in BMC Public Health, assessed health metrics from the Centers for Disease Control and Prevention’s 500 Cities Project, which covers major metropolitan areas and cities including greater Los Angeles and the Inland Empire. Investigators mapped the locations of nearly 34 000 dollar‑store outlets — including Dollar General, Dollar Tree, the 99 Cent store and Family Dollar — and analysed how many were within a 10‑minute driving distance of residential areas.
To explore spatial relationships between store access and health outcomes, researchers used geographic information system software (ArcGIS) to combine store locations with health indicators and a social vulnerability index. The authors also compared results with access to traditional grocery stores.
Key findings
- Presence of dollar stores was linked with higher rates of obesity, hypertension, cholesterol and type 2 diabetes across the analysed urban areas.
- Access to traditional grocery stores correlated with better cardiometabolic health measures.
- The results persisted after accounting for factors such as income and unemployment.
The study notes that dollar stores are classified by the US census as general merchandise outlets rather than grocery stores, and this classification can exclude them from research that examines food environments and diet.
“I want to raise awareness that higher grocery costs are pushing people to buy highly processed, lower quality food at dollar stores, and it is negatively impacting their health in a similar way to fast food,” said Ryan Bruellman, a doctoral student in genetics, genomics and bioinformatics at UC Riverside and the study’s first author.
Implications for public health
Researchers argue the findings underline how retail food landscapes influence diet and chronic disease risk. In areas where grocery prices are high or traditional supermarkets are scarce, residents may rely on dollar stores for food purchases. Those outlets often stock a larger proportion of highly processed, lower‑nutrient items compared with full‑service grocery stores, the study suggests.
Because the analysis covered multiple large metropolitan regions and adjusted for socioeconomic indicators, the authors contend the associations are robust across different urban settings. However, as an observational spatial analysis, the study demonstrates associations rather than direct causation.
What this means for readers
The research adds to a growing body of evidence that access to affordable, nutritious food is a determinant of chronic disease risk. For individuals, clinicians and community health workers, the study reinforces the importance of considering food access when addressing obesity, hypertension and diabetes prevention and management.
Readers with concerns about weight, blood pressure, cholesterol or diabetes should consult a clinician or local clinic for personalised advice rather than self‑diagnosing. Public health responses may include supporting access to full‑service grocery outlets, improving the healthfulness of products available at discount retailers, and targeted nutrition education in vulnerable communities.
| Health indicator | Association found |
|---|---|
| Obesity | Higher rates where dollar‑store access is greater |
| High blood pressure | Higher rates where dollar‑store access is greater |
| High cholesterol | Higher rates where dollar‑store access is greater |
| Type 2 diabetes | Higher rates where dollar‑store access is greater |
Policy makers, public‑health practitioners and planners may need to account for the role of non‑traditional food retailers when measuring food environments and designing interventions. The study’s authors call for greater awareness of how grocery cost pressures can shift purchasing toward highly processed foods sold in discount outlets, with potential long‑term impacts on population health.
As with any population study, further research is needed to clarify causal pathways and to test interventions that could mitigate the health risks linked to constrained food access.
