Abstract Body: Introduction: Land use rezoning policies can spur new investment and revitalization in the area. Such revitalization efforts in low-income areas have been inconsistently linked to cardiovascular disease (CVD)-related outcomes among residents. In the Bronx, New York, a large-scale neighborhood land use rezoning effort provides an opportunity to examine CVD outcomes over time.

Methods: This study compared the incidence of CVD in a retrospective cohort of initially CVD-free mid-life and older (≥ 50 years) patients of a large hospital system residing in a Bronx, New York neighborhood undergoing a land use rezoning effort (Jerome Avenue, JA, N=7413) versus residents of a comparison neighborhood (Southern Boulevard, SB, N=3757). The relative hazard of CVD was estimated using a Cox proportional hazards model, with time from the start of the rezoning (3/22/2018) to the first CVD event (heart disease, heart failure, stroke) as the outcome and followed to end of data collection window (12/31/2024); adjusted for age, sex, race/ethnicity, diabetes history, smoking status, insurance type, and neighborhood area deprivation index score.

Results: The mean age of the sample was 70.6 years (SD 9.4). Approximately 68% were female and 54% used Medicaid or Medicare to pay for services. Kaplan-Meier estimates of the incidence-free probability showed a reduced risk of CVD in JA vs. SB residents. Three-year and five-year incidence-free probabilities were 93.3% and 89.2% in JA residents compared to 92.2% and 86.5% in SB residents, with an adjusted hazard ratio of 0.865 (95%CI: 0.775-0.965; p=0.010).

Discussion: Mid-life and older adults living in an urban area undergoing a land use rezoning effort to increase affordable housing have a 13.5% lower risk of developing CVD than those living in a comparison neighborhood not undergoing the same rezoning efforts. These results provide further evidence that housing policies can influence cardiovascular health outcomes among residents.