Methodology

This year, 55 measures (including 36 weighted and 19 additional unweighted measures) were analyzed for the America’s Health Rankings 2025 Senior Report, using the most recent data available as of March 3, 2025. Data years varied by measure because of the variety of data sources. Multiple data years were combined for some measures to ensure reliable state-level estimates. Measure definitions, sources and data years are available in the Appendix: Measures Table. Measure changes were based on input from the Senior Report Advisory Committee and are detailed on the 2025 Senior Report Measures Selection and Changes webpage.

Each state was ranked according to its value for each measure, with a rank of No. 1 assigned to the state with the healthiest value. Ties in value were assigned equal ranks. If a state value was unavailable for a measure in this edition, it was noted as unavailable or suppressed. Summations were generated overall and by model category. Summations show how a state compares with other states for a model category, such as Social and Economic Factors or Overall.

Overall state rankings were based on 36 weighted measures that:

The state value for each measure was normalized into a z-score, hereafter referred to as “score,” using the following 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 a state’s overall score. If a U.S. value was unavailable from the original data source for a measure, the mean of all states and the District of Columbia was used. If a value was unavailable 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 volunteerism and flu vaccination, were multiplied by 1. In contrast, measures with a negative association, such as smoking and early death, were multiplied by -1. A state that ranked No. 1 will have a higher summation score (e.g., 2.00), reflecting better health, whereas a state that ranked No. 50 will have a lower summation score (e.g., -2.00). The overall state ranks were calculated by ranking the overall summation score, which included all 36 weighted measures in the model (see Measures, Weights and Direction for model and measure weights).

Scores and ranks were not calculated for the District of Columbia because of its unique status as an entirely urban population with different governing and funding mechanisms than states. While the District of Columbia was not included in the overall state rankings, its data are available in this report and on the America’s Health Rankings website.

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Findings. Data for all measures are analyzed and considered for inclusion in the report. Measures with updated data, statistically significant national changes and new measures on emerging topics are prioritized for selection (based on nonoverlapping 95% confidence intervals, when available).

Health Disparities. Health disparities highlight significant differences within measures based on age, disability status, education, gender income, metropolitan status, race/ethnicity, sexual orientation and veteran status where data are available. Priority goes to groups with the largest health disparities while considering relevant risk factors. Not all significant differences are detailed in the report. Full demographic data are published on the America’s Health Rankings website. Health disparities are presented as a ratio calculated by dividing the value of one group by the value of another. For example, the value of the group with the highest value may be divided by the value of the group with the lowest value. Only measures with significant differences, determined by nonoverlapping 95% confidence intervals, are considered. For more information, see Disparity Measures Methodology.

Strengths and Challenges represent measures most impacting a state’s overall ranking. Measures with newly available data that span model categories and topic areas are given priority during selection. Unweighted measures are excluded from the ranking calculations, and D.C. is assessed separately by comparing its values to those of the healthiest and least healthy states. The U.S. summary is a reference for calculating z-scores and the overall rankings, so it does not include strengths and challenges. 

Key Findings highlight notable trends, presented as percentage changes between two time periods. Only statistically significant changes, as determined by nonoverlapping 95% confidence intervals, are considered for measures with confidence intervals. Measures without confidence intervals are considered if the change is 5% or more between the two time periods. Priorities are to include a mix of measures that are either improving or worsening across model categories and topic areas. Measures that do not lend themselves to changes over time are excluded from the analysis.

Analyses were performed to illuminate health disparities by age, disability status, education, gender, income, metropolitan status, race/ethnicity, sexual orientation and veteran status. Not all groups were available for all data sources and measures. Individual estimates were suppressed if they did not meet the reliability criteria laid out by the data source or internally established criteria. Some values had wide 95% confidence intervals, meaning the true value may be far from the estimate listed.

Age. Age data in this report were available for measures from CDC WONDER and the Fatality Analysis Reporting System. Behavioral Risk Factor Surveillance System (BRFSS) groupings included the age ranges: 65-74, 75-84 and 85 and older. Fatality Analysis Reporting System groupings included the age ranges 65-74 and 75 and older.

Disability Status. Disability status data in this report were available for measures from BRFSS. Groupings were based on responses to the questions in the core disability section: “Are you deaf or do you have serious difficulty hearing?” “Are you blind or do you have serious difficulty seeing, even when wearing glasses?” “Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?” “Do you have serious difficulty walking or climbing stairs?” “Do you have difficulty dressing or bathing?” and “Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping?” Responses of no or missing to all questions, with at least one response being no, were coded as without a disability.

Education. Education data in this report were available for measures from BRFSS, the American Time Use Survey and the Volunteering and Civic Life Supplement. BRFSS groupings were based on responses to the question, “What is the highest grade or year of school you completed?” American Time Use Survey and Volunteering and Civic Life Supplement groupings were based on responses to the question, “What is the highest level of school you have completed or the highest degree you have received?”

Gender. Gender data in this report were available for measures from BRFSS, the Bureau of Labor Statistics’ American Time Use Survey and the Current Population Survey’s Volunteering and Civic Life Supplement. This report stratified gender as men and women but acknowledges that not all people identify as belonging to one of these 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 some national surveys limit the ability to describe the health of transgender and nonbinary individuals, especially at the state level.

Sexual Orientation. Sexual orientation data in this report were available for measures from BRFSS. Groupings were based on responses to the question, “Which of the following best represents how you think of yourself?” Responses of lesbian or gay, gay, bisexual or something else were summed and classified as LGBQ+. Responses of straight — that is, not gay — were summed and classified as straight. 

Income. Income data in this report were available for measures from BRFSS, the American Time Use Survey and the Volunteering and Civic Life Supplement. BRFSS groupings were based on responses to the question, “[What] is your annual household income from all sources?” American Time Use Survey and Volunteering and Civic Life Supplement groupings were based on responses to the question, “Which category represents your total combined income during the past 12 months (or the total combined income of all members of your family living in the household)? This includes money from jobs, net income from business, farm or rent, pensions, dividends, interest, social security payments and any other money income received by you (or by members of your family living in the household who are 15 years of age or older).” 

Metropolitan Status. Metropolitan status data in this report were available for measures from BRFSS and the Volunteering and Civic Life Supplement. Groupings were coded based on respondents’ residence. Identification as large central metro, large fringe metro, medium metro or small metro was classified as metropolitan, and identification as micropolitan or noncore was classified as nonmetropolitan (sometimes referred to in this report as rural). Volunteering and Civic Life Supplement groupings were based on the 2010 definitions of metropolitan statistical area as determined by the Census Bureau. 

Race/Ethnicity. Data were provided where available for the following racial and ethnic groups: American Indian/Alaska Native, Asian, Black or African American (classified in this report as Black), Hispanic or Latino/a (classified as Hispanic), Native Hawaiian or Other Pacific Islander (classified as Hawaiian/Pacific Islander), white, multiracial and those who identify as other race. Hispanic ethnicity includes members of all racial groups. BRFSS, CDC WONDER, American Time Use Survey and the Volunteering and Civic Life Supplement race groupings are all non-Hispanic, while the American Community Survey and the Centers for Medicare & Medicaid Services’ Mapping Medicare Disparities Tool race groupings are Hispanic-inclusive, except for white, which is non-Hispanic.

Veteran Status. Veteran status data in this report were available for measures from BRFSS and the Volunteering and Civic Life Supplement. BRFSS groupings were based on responses to the question, “Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit?” Volunteering and Civic Life Supplement groupings were based on responses to the question, “Did you ever serve on active duty in the U. S. Armed Forces?”

Rankings are a relative measure of health. Not all changes in rank translate into actual declines or improvements in health. 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 have been updated on the America’s Health Rankings website to reflect known errors and updates from the reporting source.

Use caution when interpreting data as many measures are self-reported and rely on an individual’s perception of health and behaviors. Additionally, some health outcome measures are based on respondents being told by a health care professional that they have a disease and may exclude those who have not received a diagnosis or sought or obtained treatment.

This report provides health disparity data on various demographic group characteristics alongside socioeconomic factors and environmental influences. Relying solely on health disparity data may lead to misinterpretations of health outcomes, as they do not account for the social drivers that significantly impact individuals’ access to care, quality of life and overall well-being.⁶⁵

Inclusivity in data collection is essential to documenting, analyzing and addressing the health disparities people experience. Equitable systems must accurately represent diverse populations throughout the data life cycle, including data collection, analysis and interpretation.⁶⁶

Inadequate representation of populations may hinder the identification of trends and patterns within different demographic groups and limit the ability to tailor public health interventions and personalize care that empowers people to make better health choices.