Place, Population, and Inequality: A Cross-Sectional National Analysis of Disparities in Neighborhood Physical Activity Environments Across the Urban-Rural Spectrum

Objectives. Neighborhood physical activity environments (PAEs)-including walkability, recreational facilities, green space, and civic infrastructure-support active living and population health but are often inequitably distributed. This study examines racial/ethnic and socioeconomic disparities in neighborhood PAEs and assesses variation by urbanicity. Methods. We used population-weighted ordinary least squares regression models with county fixed effects using the latest available 2018 data from 69,889 census tracts in the contiguous United States. Models assessed associations between racial/ethnic and poverty composition and four PAE dimensions-built, physical facilities, natural, and social environments. Sensitivity analyses compared models with and without county fixed effects and population weighting. Urbanicity-stratified models examined disparities across urban, suburban, town, rural, and mixed settings. Results. Non-Hispanic White and low-poverty populations had greater access to PAEs across all domains, except that low-poverty populations lived in areas with lower walkability. Disparities were largest in urban and suburban areas. Rural high-poverty populations had more natural resources but less infrastructure and civic support. County-fixed effects reversed the walkability advantages for non-Hispanic Black observed in unadjusted models. Conclusions. PAE disparities disproportionately affect racial/ethnic minority and high-poverty populations, especially in urban areas. Findings support equity-focused, context-specific interventions for environmental justice in health policy.