Communities with greater access to dollar stores tended to have higher rates of several chronic health conditions, while greater access to traditional grocery stores was associated with better health measures, according to a new nationwide analysis.
The study, published in BMC Public Health, examined the food retail environment across major U.S. metropolitan areas and compared access to dollar stores and traditional grocery stores with community-level rates of obesity, high blood pressure, high cholesterol and type 2 diabetes. The findings point to a relationship between the types of stores available in a community and population health, but they do not show that shopping at dollar stores causes disease.
Researchers used data from the Centers for Disease Control and Prevention’s 500 Cities Project and mapped the locations of Dollar General, Dollar Tree, Family Dollar and 99 Cents Only stores, along with traditional grocery stores. Together, the dollar store chains represented about 34,000 locations.
They then calculated how many stores were within a 10-minute drive of residential areas and compared those patterns with local health measures.
Across the regions studied, greater proximity to dollar stores was associated with higher rates of obesity, high blood pressure, high cholesterol and type 2 diabetes. Greater access to traditional grocery stores, meanwhile, was associated with more favorable health measures.
Those relationships persisted even after researchers accounted for social vulnerability, which includes factors such as income, unemployment and other socioeconomic conditions that can affect people's ability to obtain food and health care.
The results do not mean that buying groceries at a dollar store makes someone more likely to develop these conditions.
The analysis looked at communities rather than individual shoppers. Researchers did not know which stores residents actually visited, what foods they bought or what they ate. Dollar stores may also be more common in communities already facing economic, transportation or health challenges that were not fully captured by the analysis.
The study also treated traditional grocery stores and dollar stores as different types of food environments based on their typical offerings. Researchers did not inspect the nutritional quality of food sold at every individual location.
That distinction matters because dollar stores increasingly serve as grocery sources, particularly in communities where full-service supermarkets may be harder to reach or where food budgets are tight.
“I want to raise awareness that higher grocery costs are pushing people to buy highly processed, lower quality food at dollar stores, and it is negatively impacting their health in a similar way to fast food,” said study author Ryan Bruellman of the University of California, Riverside.
The study itself, however, cannot determine whether the foods sold at dollar stores were responsible for the health patterns researchers observed.
Geography also mattered. Dollar stores were especially common relative to traditional grocery stores in parts of the South and Midwest, while the researchers noted that their data could not fully capture other food sources in some cities, such as bodegas and independent neighborhood markets.
That makes the findings less about any single retailer and more about the broader mix of food choices available to people where they live.
Dollar stores are generally classified as general merchandise retailers rather than grocery stores, which means they can be overlooked in research examining food access. As these stores increasingly sell groceries, the researchers argue that they should be considered part of the local food environment.
The findings also raise a broader question about what improving food access should mean. Simply having somewhere nearby to buy food may not be the same as having convenient access to a wide range of nutritious options.
Bruellman suggested that approaches could include expanding fresh food offerings in dollar stores or increasing access to farmers markets and food banks in communities where traditional grocery options are limited.
The study does not establish that those strategies would improve health. But it suggests that understanding where people can shop, and what kinds of foods those stores typically offer, may be important when researchers and policymakers think about the relationship between food access and chronic disease.
The research received support through a National Institutes of Health-funded project examining lifespan behavioral development and cognitive aging.