Metropolitan and Nonmetropolitan Health Deserts in the Southeastern United States: Socioeconomic Impacts and Diverging Results

highlights: • Food and physical activity deserts have limited access to fresh grocers and activity outlets. • Health deserts are areas where food and physical activity deserts overlap. • Socioeconomic and health factors impact the location of food, physical activity, and health deserts. • Major differences among desert types occurred between metropolitan and nonmetropolitan counties. abstract: Regions with limited access to fresh foods, termed food deserts, are associated with chronic disease and are often located in regions with higher rates of poverty, especially in majority-minority neighborhoods. Additionally, many neighborhoods with significant populations of minority residents and regions with higher rates of poverty are associated with limited access to physical activity, termed physical activity deserts. Therefore, regions where food and physical activity deserts overlap, or health deserts, may also be associated with the same socioeconomic and health-related issues. The purpose of this study is to analyze the potential impacts that various socioeconomic and comorbidity factors may have on the location of food, physical activity, and health deserts in the Southeastern United States, and compare results across metropolitan and nonmetropolitan counties in the region. Results indicate some similarities and differences between county types. While population and median age impacted all desert types, metropolitan desert types were significantly impacted by disability rates and minority populations, and nonmetropolitan desert types were significantly impacted by unemployment rates, poverty rates, and educational attainment (with some variation between models sets). These results suggest that urbanization may play a role in how these variables impact the occurrence of food, physical activity, and health deserts.