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Background: It is well documented that perceived neighborhood environment is associated with cardiovascular (CV) health factors but little is known about how neighborhood environment perception (NEP) relates to routine healthcare utilization, a likely determinant of CV health outcomes.Methods: Using cross-sectional Dallas Heart Study data, we examined the relationship between NEP and routine healthcare utilization. NEP was defined via total score and sub-scores using factor analysis [perceived neighborhood violence, physical environment (i.e. aesthetics), and social cohesion; higher score=more unfavorable perception]. Routine healthcare utilization was based on self-reported time since last visit to a healthcare provider for routine checkup. We used linear regression to determine the relationship between NEP scores and routine healthcare visits, adjusting for age, sex, race/ethnicity, income, education, health insurance status, CV disease burden, and neighborhood deprivation index (NDI).Results: Within the study population (N=1756; 58% black, 27% white and 15% Hispanic), those who reported more recent routine visits were found to be older, more educated and have higher income. When adjusting for confounders (Table), more unfavorable NEP was associated with less frequent routine healthcare visits. Specifically, individuals who perceived a more unfavorable neighborhood physical environment or greater violence level reported greater time since last routine visit. There was no relationship between perceived social cohesion and healthcare usage.Conclusions: Unfavorable NEP was found to significantly relate to decreased routine healthcare utilization even when accounting for health insurance, CV disease and NDI. Furthermore, unfavorable perceived neighborhood violence and physical environment are associated with less routine healthcare utilization. Our findings suggest that NEP may act as a barrier to routine preventive healthcare and ideal CV health outcomes in at-risk communities.