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Over recent decades, planners in the U.S. have increasingly adopted mixed-use projects to reduce automobile dependency and strengthen local community identity, although results remain inconsistent across cities. Urban health and fitness outcomes are shaped by complex interactions between the built environment, socioeconomic factors, and demographic characteristics. This study introduces a Health and Fitness Index (HFI) for 28,758 U.S. ZIP codes, derived from normalized measures of walkability, healthcare facility density, and carbon emissions, to assess spatial disparities in health-supportive environments. Using four modeling approaches—lasso regression, multiple linear regression, decision trees, and k-nearest neighbor classifiers—we evaluated the predictive importance of 15 urban and socioeconomic variables. Multiple linear regression produced the strongest generalization performance (R2 = 0.60, RMSE = 0.04). Key positive predictors included occupied housing units, business density, land-use mix, household income, and racial diversity, while income inequality and population density were negatively associated with health outcomes. This study evaluates five statistical formulations (Metropolis Hybrid Models) that incorporate different combinations of walkability, land-use mix, environmental variables, and socioeconomic indicators to test whether relationships between urban form and socioeconomic conditions remain consistent under different variable combinations. In cross-sectional multivariate regression, although mixed-use development in high-density areas is strongly associated with healthcare facilities, these areas tend to serve younger and more racially diverse populations. Decision tree feature importance rankings and clustering profiles highlight structural inequalities across regions, suggesting that enhancing business diversity, land-use integration, and income equity could significantly improve health-supportive urban design. This research provides a data-driven framework for urban planners to identify underserved neighborhoods and develop targeted interventions that promote walkability, accessibility to health infrastructure, and sustainability. It contributes to the growing literature on urban health analytics, integrating machine learning, spatial clustering, and multidimensional urban indicators to advance equitable and resilient city planning.
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