METHODS: To examine the health gaps among counties within states, excess deaths were calculated by asking how many fewer people could die prematurely if they lived as long as those in healthier counties of the state (best performing 10%). These excess deaths represent the differences in premature mortality rates among counties within states and the number of people who experience these differences. Health factors with meaningful gaps (statistically significant differences and/or ratios of notable size) between the state’s or poor performing counties’ value and that of a U.S. or state reference value were identified as opportunities for improvement for each state. The 2015 County Health Rankings provided all data.
RESULTS: From 2011-2013, nearly 170,000 or approximately 1 in 7 (15%), deaths nationwide could have been avoided every year if all counties had the same premature mortality rate as healthier counties in their state or region. Among counties in each state, sizeable health gaps were observed - the percentage of excess deaths ranging from 7% (Arizona) to 32% (Colorado). The most commonly identified health factors to improve included poverty, unemployment, smoking, and high school graduation. Compared to overall U.S. values, states with the biggest gaps for these measures were Mississippi, Nevada, West Virginia, and Nevada, respectively. South Dakota, Arizona, Alaska, and South Dakota, respectively, had the biggest within-state gaps for these measures.
CONCLUSIONS: Substantial gaps in health exist across states and counties in the U.S., revealing that in each state not everyone has a fair chance to be the healthiest they can be. Characterizing the magnitude of these gaps and identifying areas with the greatest potential to improve health for all can help state policymakers and community leaders set policy priorities and target resources to help close the gaps.