Disparities in the healthiness of food outlets across socioeconomic index for areas and local government areas in Illawarra and Shoalhaven region, Australia

Poor diet is a risk factor for chronic noncommunicable diseases and related mortalities (1) . The community food environment is one of the determinant factors for dietary quality (2) . In high-income countries, the dietary impact of the community food environment is more pronounced in low socioeconomic areas (3) . This study aimed to assess the healthiness of food outlets and its association with Socioeconomic Index for Areas (SEIFA) and Local Government Areas (LGA) in the Illawarra Shoalhaven region, Australia. A desk-based cross-sectional study was conducted using a list of registered food outlets obtained from councils of local government areas. Food Environment Score was used to assess the healthiness of food outlets that classify food outlets as healthy, less healthy, and unhealthy (4) . The Index of Relative Advantage and Disadvantage (IRSAD) at statistical area level two was used to define SEIFA and was extracted from the Australian Bureau of Statistics (ABS) 2021 census data. Logistic regression was conducted to identify the association between the healthiness of food outlets with LGA and SEIFA. Of the 1924 food outlets, 52.4% (n = 1008) were in Wollongong, 14.1% (n = 272) in Shellharbour, 8.3% (n = 160) in Kiama, and 25.2% (n = 484) in Shoalhaven LGA. Out of 1924 food outlets, 281 (14.6%) were categorised as healthy, 790 (41.1%) as less healthy, and 853 (44.3%) as unhealthy. Wollongong had 2 times more unhealthy food outlets than Shoalhaven as compared to healthy and less healthy food outlets (AOR 2.0 (95% CI: 1.5, 2.5)), Shellharbour had 70% more unhealthy food outlets than Shoalhaven as compared to healthy and less healthy food outlets (AOR 1.7 (1.3, 2.3)), and Kiama had 70% more unhealthy food outlets than Shoalhaven as compared to healthy and less healthy food outlets (AOR 1.7 (1.1, 2.5)). IRSAD 5 had 40% fewer unhealthy food outlets than IRSAD 3 as compared to healthy and less healthy food outlets (AOR 0.6 (0.4, 0.8)) and IRSAD 4 had 50% fewer unhealthy food outlets than IRSAD 3 as compared to healthy and less healthy food outlets (AOR 0.5 (0.3, 0.8)). Large proportion of food outlets were categorised as unhealthy and less healthy. There were disparities in the healthiness of food outlets across LGAs and SEIFA. Intervention strategies need to be designed to increase the availability of healthy food outlets and limit unhealthy food outlets, particularly in low socioeconomic areas.