Socioeconomic Inequalities in Exposure to Neighborhood Food Environments: A Systematic Review.

INTRODUCTION: Socioeconomic inequalities in dietary behaviors and consequent health outcomes may be partly driven by unequal exposure to neighborhood food environments. This systematic review synthesized evidence on individual- and area-level socioeconomic inequalities in exposure to neighborhood food environments in high-income countries. METHODS: We conducted systematic searches in MEDLINE, Embase, Web of Science, and Scopus in February 2024 and updated the search in April 2026. Eligible studies were quantitative, included objective food environment measures and reported at least one indicator of socioeconomic position (SEP). Title and abstract screening was supported by ASReview with all decisions made manually; full texts were screened in duplicate. Data extraction followed a predefined form, and study quality was assessed using an adapted version of the AXIS tool. Results were synthesized narratively and by reporting the proportion of associations indicating relatively advantageous, disadvantageous, or nonstatistically significant differences in exposure for populations with a lower SEP. RESULTS: A total of 167 studies were included. Populations with lower SEP tended to experience modestly greater exposure to some unhealthy food outlets, while differences in exposure to healthy outlets were predominantly mixed or nonstatistically significant. Substantial heterogeneity was observed across SEP indicators, food environment measures, geographical contexts, levels of analysis, and statistical approaches, limiting comparability across studies and precluding meta-analysis. CONCLUSION: Neighborhood food environments in high-income countries show modest but meaningful socioeconomic inequalities, driven mainly by higher exposure to some unhealthy outlets among populations with a lower SEP. Addressing these disparities may require more standardized exposure measures and equity-focused policy approaches.