A cross-sectional analysis of disparities in neighborhood physical activity environments across the urban-rural Spectrum in the contiguous United States.

Abstract

Neighborhood physical activity environments (PAEs), including built, facility, natural, and civic environments, support active living but are inequitably distributed. We examined racial/ethnic and socioeconomic disparities in PAEs and described variations by urbanicity. We used population-weighted multivariable ordinary least squares regression with urbanicity and county fixed effects (2018; 69,889 contiguous United States census tracts) to estimate associations between standardized PAE indicators across four dimensions (built, facilities, natural, social) and categorical racial/ethnic composition and neighborhood poverty. Sensitivity analyses compared models with and without county fixed effects and weighting; urbanicity-stratified models examined variations. Non-Hispanic Black and Hispanic tracts had lower land-use mix (β = -0.53; -0.31), fewer fitness centers (β = -0.51; -0.60), lower green space (β = -0.08; -0.33), and higher pollution (β = 0.18; 0.38) than non-Hispanic White tracts. High-poverty tracts had greater road and intersection density (β = 0.29; 0.36), fewer fitness centers (β = -0.15), lower green space (β = -0.23), and lower civic engagement (β = -0.97). Their 95% confidence intervals excluded 0. Associations were generally larger in urban and suburban areas. County fixed effects reversed walkability advantages for non-Hispanic Black tracts. Findings underscore the need for equitable environmental investment that supports active living.