Bronx Neighborhood Redevelopment and CVD in mid-life and older adults

Summary/Abstract Cardiovascular disease (CVD) accounts for 1 in 4 deaths a year in the US. CVD-related risk factors such as hypertension and diabetes emerge in mid-life (50-64 years old) compromising healthy aging into older adulthood (65 yrs+). Mid-life also shows a widening in socio-demographic disparities in CVD-related risk factors. Disparities (e.g., those related to income, race, and ethnicity) are driven in part by “social determinants of health” like neighborhood resources. Resources—including sources of healthful food and amenities for physical activity—tend to be fewer in number and lesser in quality in certain neighborhoods. Recognizing this reality, there is increasing policy interest in redeveloping under-resourced neighborhoods. “Neighborhood redevelopment” is a process through which rezoning and capital investment can bring new resources to neighborhoods—e.g., sources of healthful food and amenities for physical activity. While redevelopment might therefore support better health (including health related to CVD), potential benefits may not be realized equally among all socio-demographic groups. For example, if housing costs increase as neighborhood resources improve, residents having lower income or fixed budgets may be increasingly challenged to afford other health- related needs. In fact, the net impact of neighborhood redevelopment among different socio-demographic groups is not clear. Better data is needed to understand how redevelopment could affect health and health disparities. To examine the relationship between neighborhood redevelopment and CVD-related health/health disparities, the proposed study will use three complementary approaches: (1) a natural experiment, (2) qualitative analysis, and (3) micro-simulation and systems dynamics modeling. First, we will take advantage of a redevelopment initiative in the Bronx, NY, where a largely commercial area is being rezoned and capital investments are being made to increase healthful neighborhood resources. Using a primary care sample identified through electronic health records, we will follow cohorts of mid-life and older patients in both the redevelopment area and a comparison area. We will compare clinically measured incident CVD and other CVD-related risk factors to understand how redevelopment effects cardiovascular health over time. In particular, we will examine the mediating effects of food and physical-activity and related resources. Second, through purposively sampling of informative patients, we will use in-person “walk-along” interviews to understand how residents perceive neighborhood access to healthful resources during ongoing redevelopment. Third, we will use a validated micro-simulation model that projects long-term effects of redevelopment on CVD-related outcomes. Fourth, we will use system dynamics modeling to synthesize salient findings from quantitative and qualitative data sources to inform future implementation of redevelopment strategies. This study demonstrates a transferable method of quantifying the impact of redevelopment in an area actively undergoing this process using both clinical and community data.