IntroductionThe Health of Tomorrow’s SeniorsFindingsTop and Bottom StatesChange in RankFuture PerspectiveCore MeasuresBehaviorsCommunity & Environment: MacroPolicyClinical CareOutcomesSupplemental MeasuresState SummariesAlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDistrict of ColumbiaAppendixDescription of Core MeasuresDescription of Supplemental MeasuresMethodology2016 Model Development2016 Senior Health Advisory GroupThe TeamExecutive SummaryConclusionAmerica’s Health Rankings® Expansion
Population Growth Projections
In 2011 the oldest of the baby boomer generation turned 65, marking the beginning of a tremendous demographic shift in the US population.  By 2056, the population of adults aged 65 and older is projected to surpass the population younger than 18 years.  Each day through 2030, 10,000 baby boomers will turn 65, which will place a heavy burden on the health care system.  Adults aged 65 and older are the largest consumers of health care as the process of aging brings upon the need for more frequent health care. 
Using population projections published by Woods and Poole in 2015, the senior US population is expected to increase by 49.5% between 2016 and 2030. This amounts to a projected annual growth rate of 3.5% in the 65 years and older population. In addition to projected increase in the aging population, the US population is expected to become more racially and ethnically diverse. The aggregate minority population in the United States is projected to become the majority by 2043.  The projected growth of the senior population in the United States will pose challenges to policymakers, Medicare, Medicaid, and Social Security, not to mention the effect it will have on families, communities, businesses, and health care providers.
The pressure that this demographic shift places on the nation is not evenly distributed among the states (Table 3), with some states expecting many more aging baby boomers than others.
The senior population is projected to increase by more than 50% in 25 states. Table 3 includes the 10 states with the highest annual growth rate and the 10 states with the lowest annual growth rate in the 65 and older population from 2016 to 2030. The growth rate and the corresponding percent growth for all states are provided on the website (www.americashealthrankings.org/reports/senior?tabname=future).
 “Baby Boomers Retire.” December 29, 2010. Pew Research Center. http://www.pewresearch.org/daily-number/baby-boomers-retire/. Accessed April 11, 2016.
 Colby SL and Ortman JM. The Baby Boom Cohort in the United States: 2012 to 2060. Population Estimates and Projections. Current Population Reports. Issued May 2014.
 Alemayehu B, Warner KE. The lifetime distribution of health care costs. Health Services Research. 39.3 (2004): 627-642.
Comparison of Health Estimates in the Middle-Aged Population, 1999 and 2014
Four health measures among the middle-aged (50-64 year olds) were examined for a broader context of the health of our nation and what’s to come when viewed in conjunction with population growth projections. The prevalence of obesity, diabetes, smoking, and very good or excellent health status in middle-aged adults in 2014 were compared to middle-aged adults in 1999. Changes in these health indicators and the demographic shifts have significant, and largely unchangeable, impacts on the population’s health.
With the increase in obesity and diabetes prevalence over the past 15 years, there has been a contemporaneous decrease in smoking prevalence. The percentage of adults aged 50-64 who smoke now is much less than the percentage in 1999. Self-reported health status has also experienced a modest decline.
The magnitude of change in obesity and diabetes prevalence between 1999 and 2014 in the middle-aged population demands our attention. Examining the estimated relative change can help states prepare for the expected economic, social, and health effects. Tables of obesity, diabetes, smoking, and health status prevalence among 50-64 year olds in 1999 and 2014, as well as the relative percentage changes for all states are available at www.americashealthrankings.org/reports/Senior?tabname=Future. See Appendix (page 141) for methodology.
The national obesity prevalence in the middle-aged population increased 25% from 1999 to 2014. While all but one state’s obesity rates have increased, they have not done so evenly. Idaho’s rate increased the least at only 2%, while obesity rates in Arizona rose by 96%. In Colorado, the obesity rate of middle-aged adults decreased by 3% over the 15-year period.
Obesity contributes to a variety of other serious chronic diseases. States with higher obesity rates may presume further health challenges are ahead. Table 4 shows the top 10 states and bottom 10 states.
Nationally, the prevalence of diabetes among the middle-aged population has increased dramatically from 1999 to 2014 with an almost 55% increase in the percentage of adults aged 50 to 64 who reported that a physician told them they had diabetes. This increase in diabetes prevalence is far more precipitous in some states than others, with nearly a 145% increase for middle-aged adults in Nebraska and a 138% increase in Colorado. Diabetes prevalence is estimated to double in six states. All states reported an increase in diabetes prevalence, with the smallest increase occurring in Montana with a single digit increase of 6%.
States with greater gains in diabetes prevalence can expect to face additional challenges over the coming years as a less healthy cohort of adults become seniors. Table 5 shows the top 10 states and bottom 10 states.
Nationally, the prevalence of smoking in the middle-aged population decreased 50% from 1999 to 2014. The public’s perception of the health risks associated with smoking have shifted over the past 15 years. Despite across the board decreases in smoking prevalence by state, there is some variation in the relative percentage change across states. Utah, Arizona, New Jersey, and Hawaii all achieved a percentage change decrease in smoking prevalence in the range of 61-67%. The relative change in the majority of other states fell somewhere between a 40-60% decrease in smoking prevalence. The smallest decrease occurred in Alabama where 31% fewer adults reported being current smokers in 2014 compared to 1999.
States with less steep declines and a higher prevalence of smokers compared to the national average can expect to face additional challenges over the coming years as the cost of chronic diseases associated with smoking are realized. The top 10 states and bottom 10 states are listed in Table 6.
Nationally, the percentage of adults aged 50 to 64 reporting very good or excellent health has decreased by 9.4% from 1999 to 2014. This drop in health status is far more dramatic in some states than others, with 18-19% fewer adults in Indiana, Kansas, New Mexico, Louisiana, and Oklahoma reporting very good or excellent health. A few states reported a modest increase in health status, with the largest percentage increase occurring in North Dakota where 2.2% more adults reported very good or excellent health. Missouri had no change in self-reported health status since 1999.
States with greater declines can expect to face additional challenges over the coming years as a less healthy cohort of adults ages. Table 7 shows the top 10 states and bottom 10 states.