Background: Neighborhood environments significantly influence children’s health. Yet, most research has focused on the harms of disadvantaged areas rather than the potential benefits of thriving communities. The health effects for children currently living in higher-opportunity neighborhoods, particularly those in historically disinvested through redlining remain unclear. This study examined the associations between neighborhood opportunity, historical redlining, and children’s cardiometabolic healthcare utilization.

Methods: We analyzed cardiometabolic disease (CMD)-related emergency department (ED) and outpatient visits among children aged 0-17 in New York State from 2018-2022 using all-payer data. Neighborhood opportunity was measured using the Child Opportunity Index (COI) 3.0 (44 indicators) and categorized into quartiles (very low to high). Poisson regression models adjusted for age, sex, and race/ethnicity. Analyses were stratified by historical redlining using Home Owners’ Loan Corporation grades (A/B=non-redlined; C/D=redlined) and by CMD subtype.

Results: Among 335,111 CMD-related visits, mean age was 7.5 years (SD=5.9); 48.7% were female. Obesity accounted for 68.5% of visits, followed by type 1 diabetes (10.3%) and hypertension (7.4%). Overall, children in high- versus low-opportunity neighborhoods exhibited 48% higher CMD-related ED visits (95%CI: 1.42-1.55) and 17% higher outpatient visits (95%CI: 1.15-1.19), with similarly elevated patterns in redlined and non-redlined areas. Most CMD subtypes showed elevated rates in high-opportunity areas (ED RRs=1.00-2.72; outpatient RRs=1.57-2.50), except for obesity-related ED visits in redlined neighborhoods (RR=0.65; 95%CI: 0.64-0.66).

Conclusion: CMD-related visits were higher in high-opportunity neighborhoods, except for obesity-related ED visits, likely due to obesity being primarily managed as chronic care. This pattern may reflect either a higher observed CMD burden from greater ED use or better healthcare access and CMD management, as seen in increased outpatient visits. Stratifying analyses by race and ethnicity could further clarify and validate these findings.