America's Health Rankings Health Disparity Data Visualization Tool

BACKGROUND:

Measuring the distribution of health determinants and outcomes by state provides useful data on the condition of the average resident but often masks important differences in health within a state’s population. When health metrics are stratified by race/ethnicity, gender, age, education, residence, and/or economic status, significant differences may emerge that are important for states to recognize. America’s Health Rankings (AHR) has published a state-by-state comparison of population health for 25 years by combining 29 metrics that represent behaviors, community and environment, policy, clinical care, and health outcomes into a comparative ranking of state health. AHR has expanded to include subpopulation data for several metrics, allowing for the examination of differences within populations.

METHODS:

Using data from BRFSS, birth and death certificates (National Vital Statistics System), NCHHSTP Atlas and the National Center for Education Statistics, 17 metrics representing health determinants and outcomes were stratified by state. These include metrics that impact chronic diseases such as smoking, obesity, physical inactivity, and binge drinking, MCH indicators infant mortality and low birthweight, and health outcomes diabetes and cardiovascular mortality. Where data allowed, the metrics were also stratified by age, education, gender, income, race/ethnicity, and urbanicity. Adults under age 25 were excluded from the education and income subpopulation groups. A web-based disparity visualization tool was designed to display the state and national data by the estimated prevalence and number of people affected by subpopulation levels.

RESULTS:

Nationally, smoking among adults varies geographically from 10.3% in Utah to 27.3% in West Virginia. Smoking prevalence among adults aged 25 and older with less than a high school degree varies from 14.7% in California to 49.7% in Alaska. Among adults aged 25 and older with a college degree, smoking varies from 2.7% in Utah to 13.3% in West Virginia. Alaska has the largest variation in smoking prevalence in adults aged 25 and older by educational attainment with 9.0% of college graduates smoking compared to 49.7% of adults with less than a high school education.

CONCLUSIONS: A web-based disparity visualization tool allows users to examine differences in health determinants and outcomes within the subpopulations in a state. AHR is a data-driven resource that can be used to identify priorities when developing actionable interventions and illustrates the impact of making changes at the state level. Improved information allows for interventions to be focused and based on current research.