Association between Urban public service facility density and chronic disease Incidence: empirical evidence from Texas, the US

Abstract Public service facility density, as a fundamental characteristic of urban built environments, exerts long-term cumulative effects on residents' physical and mental health. While existing research has extensively explored relationships between specific public service facilities and individual chronic diseases, few studies have adopted a comprehensive perspective to examine: (1) the differential impacts of coexisting facility types on various chronic conditions, and (2) distinct patterns of facility influence across different diseases. To address these gaps, we employed gradient-boosted decision trees and SHAP analysis using data from 254 counties in Texas, quantifying the relative importance of eight facility categories across eight chronic diseases and their nonlinear associations. Our findings reveal significant facility-specific influences (particularly public transit stations, cultural/recreational facilities, supermarkets, and fast-food/convenience stores) on cancer, asthma, obesity, hypertension and depression, each exhibited distinct nonlinear patterns, with behavioral pathways potentially mediating these relationships. These insights establish facility density as a valuable metric for assessing regional chronic disease risks and inform strategies for optimizing the spatial layout of urban public service facilities to promote public health.