A spatial analysis of health-related resources in three diverse metropolitan areas

Few studies have investigated the spatial clustering of multiple health-related resources. We constructed 0.5 mile kernel densities of resources for census areas in New York City, NY (n=819 block groups), Baltimore, MD (n=737), and Winston-Salem, NC (n=169). Three of the four resource densities (supermarkets/produce stores, retail areas, and recreational facilities) tended to be correlated with each other, whereas park density was less consistently and sometimes negatively correlated with others. Blacks were more likely to live in block groups with multiple low resource densities. Spatial regression models showed that block groups with higher proportions of black residents tended to have lower supermarket/produce, retail, and recreational facility densities, although these associations did not always achieve statistical significance. A measure that combined local and neighboring block group racial composition was often a stronger predictor of resources than the local measure alone. Overall, our results from three diverse U.S. cities show that health-related resources are not randomly distributed across space and that disadvantage in multiple domains often clusters with residential racial patterning.