34,021 dollar stores across the continental United States were mapped and they cluster heavily in low-income neighborhoods. People living within reach of these stores face higher rates of obesity, diabetes, and high blood pressure, according to a new study from UC Riverside published in June 2026 in BMC Public Health. The decisive factor is not the low price but what remains almost entirely absent from shelves: fresh vegetables and fruit.
What researchers measured
The team led by lead author Ryan Bruellman mapped more than 64,000 food retailers across the continental United States for the study: 30,920 conventional supermarkets and 34,021 dollar store locations from Dollar General, Dollar Tree, Family Dollar, and 99 Cent Store chains. Using travel time data, they calculated how many stores of each type were accessible within a ten-minute drive from 19,607 census tracts, representing more than 76 million people across over 50 major metropolitan areas.
The result: residents in neighborhoods with particularly high concentrations of dollar stores showed higher rates of obesity, high blood pressure, elevated cholesterol, and type 2 diabetes. This association remained even when researchers controlled for local income levels and unemployment rates. Proximity to conventional supermarkets, conversely, correlated with measurably better health outcomes.
Not the price, but quality is the problem
The intuitive objection seems obvious: dollar stores are located in poor neighborhoods and poverty makes people sick. The study addresses this exact objection. The correlation between dollar store density and poor health outcomes remained stable after researchers accounted for income and employment data.
The product selection offers an explanation, though the causal link remains unproven: dollar stores carry almost exclusively shelf-stable, highly processed products. Fresh vegetables, fruit, or dairy products are largely absent from most locations. For people who cannot reach a conventional supermarket within a ten-minute drive, these stores are often the only option available.
Bruellman and co-authors Ilana Bennett from UC Riverside, Jessica Finlay and Chandra Reynolds from the University of Colorado Boulder recommend that dollar stores establish partnerships with local farmers to expand their fresh produce selection. They also propose relocating farmers markets and food banks closer to dollar store locations, where they currently often sit farther away.
Germany: Different stores, similar questions
German discount retailers like Aldi, Lidl, or Penny are not dollar stores. They stock fresh vegetables, dairy products, and meat, rotate inventory regularly, and do not limit themselves to shelf-stable industrial goods. The product scarcity described in the U.S. study does not characterize the German discount model. The study therefore cannot be directly applied to Aldi and Lidl.
Germany's parallel to the American problem looks different: it is not a quality problem but an access problem. Around one quarter of the population in rural German regions lives more than one kilometer from the nearest food shop, according to calculations by the Federal Institute for Research on Building, Urban and Regional Development and work by the DFG Research Group on Food Access Gaps or Food Deserts in Germany. The number of small shops under 400 square meters of retail space has declined sharply since the 1960s. While discount chains opened in many communities, they now withdraw from sparsely populated regions.
Ulrich Jürgens, geographer at the University of Kiel and one of Germany's leading researchers in this field, describes a self-reinforcing effect: when one shop closes, residents change their shopping behavior, buy elsewhere, and remaining stores lose revenue. Jürgens speaks of mental food deserts: parts of the population habitually shop elsewhere, unaware they are weakening local retailers in the process.
Food access as a political responsibility
Dollar General has massively expanded its store count in the United States over the past decade, deliberately targeting neighborhoods and small towns where conventional supermarkets had previously retreated. Studies show that its presence makes new supermarket openings less likely. For remaining residents, these stores appear to be an option but are essentially no substitute for complete food supply with fresh products. The study demonstrates that this pattern has measurable consequences in disease data.
In disadvantaged German communities, automated markets have been piloted since 2020. Research shows these automated markets primarily enable supplementary shopping rather than replacing full weekly purchases. For fresh food supply, they are not yet an equivalent substitute. Agricultural ministers have discussed mobile sales solutions and state subsidies for village shops; so far, mainly pilot projects in individual states have been implemented.
The U.S. study confirms what researchers in public health have argued for years: the surrounding environment shapes what ends up on people's tables. Lower-income households not only have less money for food but often fewer options to reach a good store. The Bruellman study makes this connection measurable in one of the first large population studies. Missing fresh produce in a store is not a minor issue: it leaves measurable traces in the health of people who shop there. This is documented for American dollar stores. Whether it transfers to a German village without a supermarket remains open.