34,021 dollar stores were mapped across the continental United States and they stand almost exclusively in low-income neighborhoods. Residents living in these areas show higher rates of obesity, diabetes, and hypertension, according to a recent study from University of California Riverside, published in August 2026 in BMC Public Health. The critical factor is not the low price but what is almost never on the shelves: fresh vegetables and fruit.
What researchers measured
The team led by lead author Ryan Bruellman mapped more than 64,000 food retail locations across the continental United States: 30,920 conventional supermarkets and 34,021 dollar-store locations, primarily from Dollar General and Dollar Tree chains. Using drive-time data, they calculated how many stores of each category were reachable within ten minutes of driving from 19,607 census tracts, representative of more than 76 million people across more than 50 major metropolitan areas.
The result was clear: residents in areas with particularly high dollar store density showed elevated rates of obesity, hypertension, elevated cholesterol, and type-2 diabetes. This association remained even when researchers accounted for local income levels and unemployment rates. Proximity to conventional supermarkets, by contrast, correlated with measurably better health outcomes.
Not price, but quality is the problem
The intuitive objection is obvious: dollar stores locate in poor neighborhoods and poverty makes people sick. But this study addresses that objection directly. The correlation between dollar-store density and poor health outcomes remained stable after income and employment data were removed from the analysis.
The mechanism is different: dollar stores stock almost exclusively shelf-stable, ultra-processed products. Fresh vegetables, fruit, and dairy products are largely absent from most locations. For people with no conventional supermarket reachable within a ten-minute drive, these stores often become the only option.
Bruellman and co-authors Jessica Finlay and Ilana Bennett from University of California Riverside, along with Chandra Reynolds from University of Colorado Boulder, recommend that dollar stores enter partnerships with local farmers to expand their fresh produce selection. They also suggest relocating farmers markets and food banks closer to dollar-store locations, as these currently tend to concentrate in wealthier neighborhoods.
How this maps to other countries
The specific dollar-store model does not exist in Germany or most of Europe. Discount chains such as Aldi, Lidl, or Penny stock fresh vegetables, dairy, and meat, rotate inventory regularly, and are not vendors of exclusively shelf-stable industrial products. The product scarcity described in the U.S. study is not a feature of the European discount model. The findings do not directly transfer.
The European parallel is different: it is not a quality problem but an access problem. Rural populations in many countries face shrinking options as small local shops close and chain retailers pull out of sparsely populated regions. In Germany, the number of small stores under 400 square meters has declined sharply since the 1960s. Discount chains initially expanded into many communities but increasingly retreat from thinly populated areas.
Geographer Ulrich Jürgens at the University of Kiel, one of leading researchers in this field, describes a self-reinforcing cycle: when one store closes, residents change their shopping behavior, buy elsewhere, and remaining shops lose revenue. Rural populations report they perceive food access as unavailable and create that shortage themselves through changed behavior patterns, a phenomenon Jürgens calls mental food deserts.
Food access as a political question
Dollar General and Dollar Tree have massively expanded their store count across the United States in the last decade, deliberately moving into neighborhoods and small cities that conventional supermarkets had previously abandoned. For remaining residents, these stores appear to be an offering, but they are essentially not a replacement for full food supply with fresh goods. This study shows that pattern has measurable health consequences.
In structurally weak German municipalities, autonomous markets have been tested since 2020. Research shows these markets currently enable supplementary purchases rather than replacing full weekly shopping. For fresh food supply, they are not currently an equivalent replacement. Agriculture ministers have discussed mobile sales solutions and state subsidies for village stores, though to date mainly pilot projects in individual states have been implemented.
The U.S. study validates what public health researchers have argued for years: the environment determines what reaches the table. Lower-income households not only have less money for food, they often have fewer options to reach a quality store. The Bruellman study makes this connection measurable in one of the first large population-based studies on the topic. Missing fresh produce in a store is not a marginal issue: it leaves traceable marks on the health of people who shop there. That applies equally in an American dollar store and in a German village without a supermarket.