Abstract Body (Do not enter title and authors here): Background: Medical care accounts for only 10% to 20% of overall health outcomes, while the majority are shaped by social determinants of health (SDoH), environmental exposures, and individual lifestyle factors. Our previous research identified four distinct neighborhood environment clusters (NEnv 1-4) across California, with individuals in NEnv-4 (urban, low income status and low education) experiencing a 30% higher mortality rate from heart failure with preserved ejection fraction (HFpEF) compared to those in NEnv-3 (urban, high income and high education). While this study highlighted a connection between SDoH and HFpEF, the specific SDoH factors driving these outcomes remain poorly defined and require further investigation.

Research Question: What geospatial environmental and exposomic risk factors characterize neighborhood environments associated with elevated risk for heart failure with HFpEF clinical outcomes?

Methods: We built upon previously defined NEnvs by integrating a geospatial characterization layer to enhance environmental context and resolution. Leveraging OpenStreetMap to capture key social determinants of health (Fig. 1a) within the built environment (Fig. 1b). We also developed computational models to estimate neighborhood-level crowding, walkability, noise exposure, and traffic-related air pollution (Fig. 1c).

Results: As shown in Fig. 1d, NEnv-4 consistently exhibits elevated levels across multiple environmental stressors, including noise, crowding, and traffic-related pollution, suggesting a heightened cumulative risk burden. Additionally, it has the poorest walkability among all clusters. NEnv-4 also has the highest obesity prevalence among the four clusters (44.7%, p-value 0.0014), potentially reflecting limited access to fitness and recreational facilities alongside greater availability of unhealthy food options. NEnv-1 and NEnv-2 are predominantly rural, which likely contributes to their limited access to amenities and facilities. In contrast, NEnv-2 and NEnv-3 demonstrate the highest survival probabilities, along with the most favorable exposure profiles to environmental stressors and the greatest access to community resources.

Conclusions: Geospatial analysis reveals that neighborhoods with concentrated environmental hazards, including high noise, crowding, traffic pollution, and poor walkability, have 30% higher HFpEF mortality rates. These results demonstrate how place-based environmental risks drive health disparities.