Executive BriefIntroductionDesignNational FindingsKey FindingsSocial and Economic FactorsPhysical EnvironmentClinical CareBehaviorsHealth OutcomesState SummariesAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingU.S. SummaryAppendixMeasuresData SourcesMethodologyNational Advisory CommitteeThe Team
Data were pulled from four primary sources for which ten years or more of annual data are available. All primary sources are large enough to allow state-level subpopulation analysis, and collect the data needed to form the subpopulations of interest. The primary sources include the following:
American Community Survey (ACS)
American Community Survey (ACS) is an ongoing statistical survey carried out by the U.S. Census Bureau, which is sent to approximately 295,000 addresses monthly, or 3.5 million per year, making it the largest survey after the decennial census that the Census Bureau administers. For most of the ACS-sourced indicators, we utilized 5-year combined ACS Public Use Microdata Sample (ACS-PUMS) data to create estimates for non-overlapping racial and ethnic groups. The ACS-PUMS contains data on approximately two-thirds of the complete ACS sample; thus, estimates derived using the PUMS data may not match that of the estimates available via five-year summary files that can be accessed via the data.census.gov website. While ACS-PUMS data was the sample most frequently used for indicator development, we also accessed ACS data via the census.data.gov website, the IPUMS National Historical Geographic Information System (IPUMS-NHGIS) website, and the U.S. Department of Housing & Urban Development’s Comprehensive Housing Affordability Strategy (HUD-CHAS) data portal.
Behavioral Risk Factor Surveillance System (BRFSS)
Behavioral Risk Factor Surveillance System (BRFSS) is the nation’s largest phone-based survey. It provides information about U.S. residents’ health-related risk behaviors, chronic health conditions and use of preventive services. Respondents include adults ages 18 years and older. Three years of combined data (2011-2013, 2014-2016, 2017-2019) were utilized to ensure reliable estimates.
Current Population Survey’s Food Security Supplement (CPS-FSS)
Current Population Survey’s Food Security Supplement (CPS-FSS) is carried out by the U.S. Census Bureau for the U.S. Department of Agriculture. It is administered annually in December to 35,000 to 40,000 households. These data consist of answers by household respondents to questions about household food expenditures, use of food assistance programs, and experiences and behaviors related to food security. We combined five years of data for each time period in order to increase sample size and improve reliability of results.
National Vital Statistics System (NVSS)
National Vital Statistics System (NVSS), administered by the U.S. Centers for Disease Control and Prevention (CDC), collects and disseminates data on the nation’s vital events including births, deaths, marriages, divorces and fetal deaths. We used data from the Natality Public Use files (2003-2006, 2012-2015, 2016-2019), Linked Birth and Death Records (2003-2006, 2011-2014, 2015-2019) and Underlying/Multiple Cause of Death files. Years of data combined and used varied by indicator for the latter data source. All NVSS data were downloaded from the CDC Wonder website. Owing to changes in how data are captured over time, data are not available for all years via a single form and it frequently was not feasible to combine data downloaded using different forms. For this reason, there are gaps in the periods analyzed for some variables.