Econ Papers Daily / 期刊论文
食物获取的集约边际及其与健康结果的关联：美国社区间异质性效应的证据
The intensive margin of food access and its association with health outcomes: evidence of heterogeneous effects across U.S. Communities
摘要
We examine how the local food environment relates to health by shifting attention from the extensive margin (counts of food outlets) to the intensive margin, measured by the sales share of healthful retailers. Using a large national establishment dataset merged with tract-level health outcomes, we construct a sales-based healthfulness index of tract-level food environments and estimate its relationship with obesity, diabetes, high blood pressure, mental health issues, and depression of residents. We apply double/debiased machine learning with cross-fitting to flexibly adjust for high-dimensional socioeconomic and built-environment covariates and to separate intensive-margin access from overall retailer density. We find that higher healthful food-sales shares are positively associated with improved health outcomes; a 10-point increase in the healthful food sales share is associated with a 0.87 percentage-point lower obesity prevalence, a 0.19 percentage-point lower diabetes prevalence, and a 0.61 percentage-point lower high blood pressure prevalence, with similar improvements in mental health issues and depression. These associations are heterogeneous across baseline food environments: cardiometabolic outcomes respond most strongly in low-access tracts, while mental health improvements are larger in mid- and high access communities.
中文摘要
本文考察本地食品环境与健康之间的关系，并将关注点从外延边际（食品零售点数量）转向内涵边际，以健康食品零售商的销售份额来衡量。利用一个大型全国性商业机构数据集，并将其与普查区层面的健康结果数据合并，我们构建了普查区食品环境的基于销售额的健康度指数，并估计其与居民肥胖、糖尿病、高血压、心理健康问题和抑郁症之间的关系。我们采用双重/去偏机器学习并结合交叉拟合，以灵活调整高维社会经济和建成环境协变量，并将内涵边际可及性与零售商总体密度分离。我们发现，较高的健康食品销售份额与更好的健康结果呈正相关；健康食品销售份额每提高10个百分点，肥胖患病率降低0.87个百分点，糖尿病患病率降低0.19个百分点，高血压患病率降低0.61个百分点，心理健康问题和抑郁症也有类似改善。这些关联在基线食品环境之间存在异质性：心血管代谢结果在低可及性普查区反应最强，而心理健康改善在中、高可及性社区更大。