American Journal of Preventive Medicine · Nov 2, 2026

Quantifying benefit and cost-effectiveness of additional investment in community health workers for people with cardiovascular risks in New York City

By Frechette JM, Morse M, McNatt ZZ et al.

Introduction: To estimate the life expectancy gains, cost effectiveness, and impact on life expectancy inequality achieved by additional investment in community health worker (CHW) programs in New York City Methods: Using a state-transition model of mortality-driving conditions adapted to New York City anchored to 2021, we examined the impact of additional investment in CHWs for people with obesity, hypertension, and diabetes on (1) change in life expectancy, (2) health-inclusive (lifespan) return on investment (LROI), and (3) change in inequality of life expectancy distribution between neighborhoods. Inequality analyses included neighborhood-level baseline life expectancy, median income, and plurality race or ethnicity. Analyses were conducted in 2026. Results: Scaling up CHWs results in a 0.13-year life expectancy gain on the citywide level, with favorable LROI of 14.72 years per $100,000 invested. Neighborhood-level gains range from 0.05 years to 0.33 years, while LROI ranges from 11.76 to 29.62 life-years/$100,000. In general, life expectancy gains and LROI were higher for lower-income, lower life expectancy, and minoritized race neighborhoods. Conclusions: Additional investment in CHW programs in New York City has the potential to cost-effectively raise the citywide life expectancy while reducing inequalities between neighborhoods.

doi.org/10.1016/j.amepre.2026.108626 PubMed 42971447 Interventions