Evaluating Racial Disparities in Food Access and Their Impact on Body Mass Index Among Individuals With Traumatic Spinal Cord Injury.

Abstract

To investigate racial disparity in food access and its effect on obesity (measured by body mass index, BMI) among individuals with traumatic spinal cord injury (tSCI). Cross-sectional analysis of data from the U.S. National Spinal Cord Injury Database linked with the United States Department of Agriculture Food Access Research Atlas, examining participants' residences in low-income, low-access (LILA) areas and their BMI. Data were collected from U.S. Spinal Cord Injury Model Systems centers, with participants living in various communities. A final sample of individuals with tSCI (n=4177) was included, selected based on their completion of follow-up assessments between October 2006 and November 2021. Participants were aged >19 years and self-identified as non-Hispanic White, non-Hispanic Black, or Hispanic. Other racial/ethnic groups were excluded because of small sample sizes. Not applicable. The primary outcome measure was obesity, defined as BMI ≥30 kg/m². Food access was categorized using the United States Department of Agriculture criteria for LILA tracts. Significant racial disparities in food access were observed, with 21.7% of non-Hispanic Black and 13.9% of Hispanic individuals residing in LILA tracts, compared with 7.9% of non-Hispanic White individuals (P<.05). However, living in a LILA tract was not significantly associated with increased obesity risk (odds ratio, 1.22; 95% confidence interval, 0.97-1.54; P=.09). Our data revealed racial inequity in food access among individuals with tSCI, with minoritized groups being disproportionately affected. However, no significant association was found between food access and obesity. Future studies are needed to explore how food access interacts with other factors affecting health outcomes in this population.