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Individual Measures

This year 121 measures were analyzed for the Health of Women and Children Report. For each measure the most recent data available as of August 10, 2022 are presented as the value. Data years varied by measure due to the variety of data sources. For some measures, multiple years of data were combined to ensure reliable state-level estimates. Measure definitions, sources and data years are available in the Appendix: Measures Table. The ranking is the ordering of each state according to its value, with a rank of 1 assigned to the state with the healthiest value. Ties in value were assigned equal ranks. If a state value was not available for a measure in this edition, the state value was noted as unavailable or suppressed. It is important to note that rankings are a relative measure of health. Not all changes in rank translate into actual declines or improvements in health. For additional methodology information, submit an inquiry at Americashealthrankings.org/about/page/submit-an-inquiry.

Overall, Model Category and Health Topic Summations

Summations were generated overall, by women and children, and by model category and health topic. They show how a state compared with other states for a specific health topic, such as economic resources, or a model category, such as social and economic factors.
Overall state rankings were based on 84 weighted measures that met the following criteria:
  • Represent issues that affect population health for women, infants or children.
  • Have data available at the state level.
  • Use common measurement criteria across the 50 states.
  • Are current and updated periodically.
  • Are amenable to change.

Calculation of Summation Measure Rankings

The state value for each measure was normalized into a z-score, hereafter referred to as score, using the following formula:
z-score formula
The score indicates the number of standard deviations a state value was above or below the U.S. value. Scores were capped at +/- 2.00 to prevent an extreme score from excessively influencing the state’s overall score. If a U.S. value was not available from the original data source for a measure, the mean of all states and the District of Columbia was used. If a value was not available for a state, its value from the most recent available data year was used to generate a score.
Summation scores were calculated by adding the products of the score for each measure multiplied by that measure’s assigned model weight and association with health. Measures positively associated with population health, such as physical activity and flu vaccination, were multiplied by 1, while measures with a negative association, such as smoking and child mortality, were multiplied by -1. A state that ranks No. 1 has a higher summation score (e.g., 2.00), reflecting better health than a state that ranks No. 50 with a lower summation score (e.g., -2.00). Overall state rank was calculated by ranking the overall summation score, which included all 84 measures with weights in the model (see Measures, Weights and Direction for model and measure weights).

Data Notes

The overall state rankings resumed with the 2022 Edition of the Health of Women and Children Report after being excluded in the 2020 and 2021 Health of Women and Children Reports due to the public health challenges presented by the COVID-19 pandemic.
The pandemic created data collection challenges in 2020 for many surveys, including the U.S. Census Bureau’s American Community Survey (ACS) and the Centers for Disease Control (CDC) and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS). Due to poor response rates in 2020, the Bureau released experimental 2020 ACS estimates. As a result, 2019 ACS data were repeated in this year’s Health of Women and Children Report. For BRFSS, all states met the minimum requirements to be included in the public-use data set for 2020. However, there were interruptions to data collection in some areas due to the pandemic. Initial shortfalls in data collection were made up for by the end of the data collection period. The anomaly in data collection timing could lead to some differences in seasonal estimates, such as flu vaccination, but estimates were still considered comparable to prior year estimates.
Data presented in this report were aggregated at the state level and cannot be used to make inferences at the individual level. Additionally, estimates cannot be extrapolated beyond the population upon which they were created. Values and ranks from prior years were updated on the America’s Health Rankings website to reflect known errors or updates from the reporting source.
Caution is suggested when interpreting data on certain health and behavioral measures. Many were self-reported and relied on an individual’s perception of health and behaviors. Additionally, some health outcome measures were based on respondents being told by a health care professional that they have a disease and exclude those who may not have received a diagnosis or sought or obtained treatment.

Subpopulation Analysis and Group Definitions

Subpopulation analyses were conducted to illuminate disparities by age, gender, race and ethnicity, education and income, as well as metropolitan status. Estimates were compared within subpopulation groups and over time to ascertain whether differences were statistically significant at the 95% confidence interval threshold. Not all subpopulations were available for all data sources, states or measures. In addition, definitions may have varied across sources, particularly for race and ethnicity. Estimates were suppressed if they did not meet the reliability criteria laid out by the data source or internally. Some values had wide confidence intervals, meaning that the true estimate may have been far from the estimate presented.
Education Education data in this report are available for measures from the Behavioral Risk Factor Surveillance System, as well as the Maternal and Child Health Bureau’s Federally Available Data (FAD) sourced from the National Vital Statistics System (NVSS). BRFSS groupings were based on responses to the question “What is the highest grade or year of school you completed?” A response of grades 9 through 11 (some high school) was classified as less than high school; a response of grade 12 or GED (high school graduate) was classified as high school or GED; a response of college 1 year to 3 years (some college or technical school) was classified as some post-high school; and a response of college 4 years or more (college graduate) was classified as college graduate. NVSS education subpopulations for births were based on the number of years of education received by the mother at time of birth as collected on the birth certificate, and were grouped into four categories: less than high school (8th grade or less; 9th through 12th grade with no diploma), high school graduate (high school graduate or GED completed), some college (some college credit, but not a degree) and college or technical school (Associate’s degree or higher). NVSS education subpopulations for death data from FAD were based on the education level that best described the highest degree or level of school completed at the time of death and were grouped into the same four categories as births.
Gender This report includes data for females and males as available through public data sources even though not all people identified with these two categories. Data did not differentiate between assigned sex at birth and current gender identity. While sex and gender influence health, the current data collection practices of many national surveys limit the ability to describe the health of transgender or gender nonbinary individuals.
Income Income data in this report are available for measures from BRFSS and the Maternal and Child Health Bureau’s FAD measures that are sourced from the Healthcare Cost Utilization Project. BRFSS groupings were based on responses to the question “[What] is your annual household income from all sources?” Responses of less than $10,000, less than $15,000 ($10,000 to less than $15,000), less than $20,000 ($15,000 to less than $20,000) and less than $25,000 ($20,000 to less than $25,000) were summed and classified as less than $25,000; responses of less than $35,000 ($25,000 to less than $35,000) and less than $50,000 ($35,000 to less than $50,000) were summed and classified as $25-$49,999; responses of less than $75,000 ($50,000 to less than $75,000) were classified as $50-$74,999; and responses of $75,000 or more were classified as $75,000 or more. According to FAD, the income subpopulations are quartiles (poorest to wealthiest) based on current year median household income obtained from Claritas.
Metropolitan Status Metropolitan status data in this report are available for measures from BRFSS and FAD. BRFSS groupings were coded based on residence geography. Identification as large central metro, large fringe metro, medium metro and small metro were classified as Metro, and identification as micropolitan and noncore were classified as Non-Metro. FAD metropolitan status groupings were based on 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties. Metro was defined as metropolitan areas with at least 1 million residents. Small to medium metro was defined as metropolitan areas of less than 1 million residents. Non-metro was defined as micropolitan, non-metropolitan and non-micropolitan areas.
Race and Ethnicity Data were provided where available for the following racial and ethnic groups: American Indian/Alaska Native, Asian, Black or African American (labeled in this report as Black), Hispanic or Latino (labeled in this report as Hispanic), Native Hawaiian or Other Pacific Islander (labeled in this report as Hawaiian/Pacific Islander), white, multiracial and those who identify as other race. Ethnicity was collected separately from race. People who identified as Hispanic or Latino may be of any race.
Racial groups were defined differently across data sources. For example, some sources combined Asian and Hawaiian or Other Pacific Islander while other sources differentiated Asian from Hawaiian or Other Pacific Islander. In most data provided, the racial and ethnic groups were mutually exclusive, meaning all racial groups were non-Hispanic.

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