Combining straight-line and map-based distances to investigate the connection between proximity to healthy foods and disease

Abstract

Healthy foods are essential for a healthy life, but accessing healthy food can be more challenging for some people than others. This disparity in food access may lead to disparities in well-being, potentially with disproportionate rates of diseases in communities that face more challenges in accessing healthy food (i.e., low-access communities). Identifying low-access, high-risk communities for targeted interventions is a public health priority, but current methods to quantify food access rely on distance measures that are either computationally simple (like the length of the shortest straight-line route) or accurate (like the length of the shortest map-based driving route), but not both. We propose a multiple imputation approach to combine these distance measures, allowing researchers to harness the computational ease of one with the accuracy of the other. The approach incorporates straight-line distances for all neighborhoods and map-based distances for just a subset, offering comparable estimates to the "gold standard" model using map-based distances for all neighborhoods and improved efficiency over the "complete case" model using map-based distances for just the subset. Through the adoption of a measurement error framework, information from the straight-line distances can be leveraged to compute informative placeholders (i.e., impute) for any neighborhoods without map-based distances. Using simulations and data for the Piedmont Triad region of North Carolina, we quantify and compare the associations between two health outcomes (diabetes and obesity) and neighborhood-level access to healthy foods. The imputation procedure also makes it possible to predict the full landscape of food access in an area without requiring map-based measurements for all neighborhoods.

20 pages, 4 figures, 4 tables. R package, data, and code available on GitHub (details in Supplementary Materials)