Neighborhood green space visits and coronary heart disease: Evidence from mobility data across nine U.S. metropolitan cities.

Background: Coronary heart disease (CHD) is the leading cause of mortality and morbidity globally and it is shaped by genetics, behaviors and the environment. While emerging evidence suggests that greenspaces can reduce cardiovascular morbidity, most studies rely on static vegetation indices (e.g., NDVI) that do not account for greenspace engagement. This study bridges that gap to examine how greenspace engagement relates to CHD, accounting for metabolic and social factors. Methods: Green space visits per person was derived from Advan Research data (2021) at the census tract-level across the nine largest U.S. metropolitan areas (MSAs) and linked with CHD prevalence and risk factors from CDC PLACES (2023). Ordinary least-squares (OLS) models assessed metro-specific associations between greenspace visits (10 visits) and CHD, adjusting for demographics, social vulnerability, Normalized Differential Vegetation Index (NDVI), and metabolic factors. Geographically weighted regression (GWR) assessed within-metro spatial variation. Results: Across the nine MSAs, higher greenspace visitation was associated with lower CHD prevalence. Each additional 10 greenspace visits per person corresponded to a 1.6 % lower CHD prevalence in Houston, 1.6 % in Atlanta, 1.5 % in Chicago, 1.5 % in Dallas, and 1.1 % in Phoenix (all Conclusions: Greenspace engagement was broadly associated with lower CHD prevalence, with notable variations among cities and across neighborhoods within each city. Strong inverse associations were noted in suburban areas and neighborhoods with elevated metabolic risk, whereas urban cores showed weaker patterns.