Cannabis outlets cluster in Michigan’s most deprived areas

Cannabis and alcohol outlets may independently and jointly influence the health of those in their surrounding neighbourhoods. State and local policy determines the establishment of cannabis and alcohol outlets in Michigan, potentially leading to their inequitable distribution and contribution to health disparities. This ecological study examined associations among deprivation, racial makeup and the individual and joint densities of cannabis and alcohol outlets within Michigan. We analysed State of Michigan cannabis and alcohol outlet licensing data within 7988 (95.3%) Michigan census block groups (CBGs) in 2023. We linked measures of CBG deprivation and per cent minority population. We used spatially structured negative binomial models to examine relationships among deprivation, racial makeup and cannabis and alcohol outlet density per capita. We also created a novel measure of CBG cannabis and alcohol outlet co-density and used spatially structured multinomial logistic regressions to characterise co-density groups. We identified 789 distinct cannabis outlets within 553 CBGs and 16 050 distinct alcohol outlets within 5407 CBGs. Greater deprivation was associated with greater cannabis (incident rate ratio (IRR): 1.24; 95% CI 1.16 to 1.33) and alcohol outlet density (IRR: 1.08; 95% CI 1.06 to 1.10). We found an inverse association between the rate of non-white population per 10 people and alcohol outlet density (IRR: 0.95; 95% CI 0.93 to 0.97). High-cannabis/high-alcohol co-density CBGs were more deprived than low-cannabis/low-alcohol and low-cannabis/high-alcohol CBGs. Cannabis and alcohol outlets independently and jointly overburden Michigan's most deprived CBGs. State and local policymakers may consider these findings when designing cannabis and alcohol outlet policy that prioritises public health equity.