OBJECTIVE: To investigate racial disparities in food access and their impact on obesity (measured by body mass index, BMI) among individuals with traumatic spinal cord injury (tSCI). DESIGN: Cross-sectional analysis of data from the U.S. National Spinal Cord Injury Database (NSCID) linked with the USDA Food Access Research Atlas, examining participants' residences in low-income, low-access (LILA) areas and their BMI. SETTING: Data were collected from U.S. Spinal Cord Injury Model Systems (SCIMS) centers, with participants living in various communities. PARTICIPANTS: A total of 4,177 individuals with tSCI were included, selected based on their completion of follow-up assessments between October 2006 and November 2021. Participants were aged >
19 years and self-identified as non-Hispanic White, non-Hispanic Black, or Hispanic. Other racial/ethnic groups were excluded due to small sample sizes. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): The primary outcome measure was obesity, defined as BMI ≥30 kg/m². Food access was categorized using USDA criteria for LILA tracts. RESULTS: Significant racial disparities in food access were observed, with 21.7% of non-Hispanic Black and 13.8% of Hispanic individuals residing in LILA tracts, compared to 7.9% of non-Hispanic White individuals (p<
0.05). However, living in a LILA tract was not significantly associated with increased obesity risk (OR 1.22, 95% CI 0.97-1.54, p=0.09). CONCLUSIONS: Our data revealed racial inequity in food access among individuals with tSCI, with minoritized populations being disproportionately affected. However, no significant association was found between food access and obesity. Future studies are needed to explore how food access interacts with other factors affecting health outcomes in this population.