Table of contents:
Our MissionOur ReportsOur Advisory CommitteesAdvisory CouncilAnnual Report Advisory CommitteeSenior Report Advisory CommitteeHealth of Women and Children Report Advisory CommitteeHealth of Those Who Have Served Report Advisory CommitteeHealth Disparities Report Advisory Committee
Our Model and MethodologyIntroductionRanking MethodologyMeasures, Weights and DirectionMeasures Selection and ChangesData Sources
AMERICAN COMMUNITY SURVEY
The American Community Survey (ACS) is an ongoing survey conducted by the U.S. Census Bureau that provides information yearly about population demographics and housing in the nation. Data are analyzed in 1-year and 5-year summations. Data can be accessed at data.census.gov.
The pandemic created data collection challenges in 2020 data for many surveys, including the U.S. Census Bureau’s American Community Survey (ACS). The Bureau has advised not to make geographical comparisons with 2020 ACS estimates due to nonresponse bias. As a result, 2019 ACS data were repeated instead of using 2020 ACS data.
BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM
The Behavioral Risk Factor Surveillance System (BRFSS) data are analyzed using STATA to account for the complex survey design. Responses of “refused”, “don’t know” or “not sure” are excluded from the analysis but are reflected in standard error and confidence interval estimates. Prevalence estimates are calculated by sex, age group, race/ethnicity, urbanicity, education and income level. For calculating subpopulation estimates, the population of interest is specified in a manner that avoids the deletion of cases; this ensures an accurate variance estimation.
Population estimates for measures from BRFSS are calculated using the specified survey weights and represent the non-institutionalized adult population ages 18 and older. Discrepancies between prevalence estimates and population estimates are likely due to random sampling error and non-random response biases.
Estimates are suppressed if the denominator was less than 50 or the random standard error was greater than 30%.
When multiple years of data from BRFSS are used to obtain an estimate, weights are adjusted to represent the average population over the multiple-year period.
BRFSS improved their survey methodology in 2011. Due to these methodology changes, 2011-present BRFSS data are not directly comparable to previous years.
CDC publishes prevalence estimates for the total adult population as the median value of the 50 states and the District of Columbia. This convention is also used for the America’s Health Rankings Annual Report. The estimates for all subpopulations are based upon the mean of all applicable records. The mean is also used for the following reports that feature specific population groups: America’s Health Rankings Health of Women and Children, America's Health Rankings Senior, America’s Health Rankings Health of Those Who Have Served and America’s Health Rankings Health of Women Who Have Served.
NATIONAL IMMUNIZATION SURVEY
The National Immunization Surveys are a group of phone surveys used to monitor vaccination coverage among children 19 to 35 months, adolescents 13 to 17 years, and flu vaccinations for children 6 months-17 years. The surveys are sponsored and conducted by the National Center for Immunization and Respiratory Diseases of the Centers for Disease Control and Prevention. Data are obtained from the ChildVax View and TeenVax View.
NATIONAL SURVEY OF CHILDREN'S HEALTH
The National Survey of Children’s Health (NSCH) is funded and directed by the Health Resources & Services Administration’s Maternal and Child Health Bureau. These data — reported by parents and guardians — provide information about children’s health and access to health care. The survey also collects information on family, neighborhood, school and social interactions. Population estimates for measures from NSCH are calculated using the specified survey weights and represent the non-institutionalized child population ages 0 to 17 years in the U.S. and in each state and the District of Columbia who live in housing units. Discrepancies between prevalence estimates and population estimates are likely due to random sampling error and non-random response biases. When calculating prevalence estimates and weighted population counts, missing values due to non-response or a “don’t know” response are not included in the denominator.
NATIONAL SURVEY ON DRUG USE AND HEALTH
The National Survey on Drug Use and Health (NSDUH) measures the use of illegal drugs, prescription drugs, alcohol, tobacco, mental disorders, treatment and co-occurring substance use and mental disorders. Estimates of substance use and mental illness at the national, state and sub-state levels are available. NSDUH data also help to identify the extent of substance use and mental illness among different sub-groups, estimate trends over time, and determine the need for treatment services.
CDC WONDER ONLINE DATABASE
Vital statistics (birth and death) data are obtained through the CDC WONDER Online Databases. Overall mortality rates, such as child mortality, include all causes of death. For other measures, the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) codes used are defined below. The crude rate is used unless otherwise noted in the definition. Data are suppressed in all instances where there are less than 20 deaths.
Drug deaths: X40-X44, X60-X64, X85, Y10-Y14 Maternal mortality: A34, O00–O95, O98–O99 (excluded late maternal death codes O96-O97) Suicide: U03, X60-X84, Y87.0
PREGNANCY RISK ASSESSMENT MONITORING SYSTEM
The Pregnancy Risk Assessment Monitoring System (PRAMS) is a joint research project by the Centers for Disease Control and Prevention (CDC) and state health departments to examine the health of mothers and infants. Surveys are completed by mothers who recently gave birth, and data on the mother’s pregnancy and her infant are collected. PRAMS is one of the only sources for such data on a state-by-state basis.
The CDC suppresses data from states where the response rate does not meet the current threshold. Beginning in 2018, the threshold was a 50% response rate. For states that collected PRAMS data but did not meet the reporting threshold for release by the CDC, state health departments were contacted directly and PRAMS data were requested for use in this report. California, Idaho and Ohio do not participate in PRAMS but conduct similar surveys. Those data are included when the questions and survey methodology are deemed consistent with PRAMS. More information about this survey can be found on the CDC PRAMS website.