Neighborhood Revitalization and Cardiovascular Disease Outcomes in Midlife and Older Adults Living in Low-Income Neighborhoods in the Bronx, New York: Protocol for a Natural Experiment and Multimethod Community-Based Study.

Background: Neighborhood revitalization is a process through which land use rezoning and capital investment can spur new resources, such as access to healthful food and amenities for physical activity. While revitalization efforts may promote cardiovascular health, their benefits may not be distributed equally across sociodemographic groups. Objective: The objective of the study is to apply a socioecological framework that uses a multimethod approach incorporating quantitative data (longitudinal electronic health records and cross-sectional surveys) and qualitative data (longitudinal "walk-a-long" interviews) to examine the short-term effect of neighborhood land use rezoning and revitalization efforts on cardiovascular disease (CVD), CVD-related health behaviors, and access to and utilization of health care. System science methods, namely microsimulation modeling and system dynamics modeling, will be used to assess the long-term effects of land use rezoning policy and revitalization efforts on cardiovascular health and ways to sustain priority health equity goals in revitalized neighborhoods. Methods: We leverage a land use rezoning initiative in the Bronx, New York, where a largely commercial area is being rezoned along with capital investments to expand healthful neighborhood resources. Using electronic health records from a single hospital system, we will follow cohorts of midlife and older adults (≥50 y) residing in both the rezoned area and a comparison area. We will assess clinically measured incident CVD and other CVD risk factors to evaluate changes in cardiovascular health over time. In parallel, we will conduct a cross-sectional survey and a purposive sampling of patients for in-person "walk-a-long" qualitative interviews to understand how residents perceive neighborhood access to healthful resources after land use rezoning. To estimate long-term effects, we will use a validated microsimulation model to project CVD outcomes and costs. Finally, we will use system dynamics modeling to integrate quantitative and qualitative findings to inform future revitalization and public health strategies. Results: Midlife and older adult patients (N=10,813) in the intervention area and the comparison area will be followed for approximately 7 years following land use rezoning and revitalization efforts to compare CVD risk between neighborhoods. The cross-sectional survey (n=300) and qualitative assessment (n=36) will increase understanding of perceptions of access to healthful resources and related health behaviors among residents. Systems science approaches will estimate long-term CVD risk and related costs associated with revitalization efforts. An advisory committee of clinical and community stakeholders will assist in interpreting results and developing dissemination strategies for their constituents. This study was funded from January 2023 until December 2026. Conclusions: This study uses a socioecological framework to provide a novel, transferable method for evaluating the impact of neighborhood revitalization efforts on cardiovascular health by combining methods to examine short- and long-term effects across individual, neighborhood, and structural (system) levels over time. Findings will inform policies aimed at reducing CVD through equitable urban revitalization.