Healthy People Determinants of Health. County Health Rankings. AHR Indicator. Leading Health Indicators (LHI) CROSSWALK

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1 1 of 7 CROSSWALK Crosswalk comparing America's Health Rankings' (AHR) indicators with those used by County Health Rankings (CHR) and Healthy People 2020's Leading Health Indicators (LHI). AHR indicators identified as supplemental are not included in the ranking model used to determine state ranks. Determinants of Health AHR Indicator Healthy People 2020 Leading Health Indicators (LHI) County Health Rankings Behavior: High School Graduation High School Graduation: % of incoming ninth graders who graduate in four years from a high school with a regular degree. (National Center for Education Statistics and State Specific Sources [NCES]) LHI: Social Determinants- High School Graduates, on-time with regular diploma (percent): % of public school students who graduate with a regular diploma 4 years after starting 9th grade. (Common Core of Data (CCD), National Center for Education Statistics) 1.High School Graduation: % of incoming ninth graders who graduate in four years from a high school with a regular degree. (National Center for Education Statistics and State Departments of Education Sources)2.Some College-% of the population age with some post-secondary education. (American Community Survey) Behavior: Vegetable Consumption Vegetables: Supplemental indicator LHI: Nutrition, Physical Activity and Obesity- Vegetable consumption (cup equivalents per 1,000 calories): Mean daily intake of vegetables (in cup equivalents per 1,000 calories) by persons aged 2 years and over (NHANES) Behavior: Reproductive and Sexual Health Teen Birth Rate: Supplemental indicator 1. LHI: Reproductive and Sexual Health- Reproductive health services receipt: sexually active females (percent): % of sexually active females aged 15 to 44 years who received reproductive health services. (National Survey of Family Growth; national data)2.lhi: Reproductive and Sexual Health- HIV 1.Sexually Transmitted Infections: the chlamydia rate per 100,000 population. (CDC) 2.Teen Birth Rate: birth rate per 1,000 female population ages (NCHS)

2 2 of 7 infection status awareness (percent): % of HIV-infected persons who are aware of their infection. (HIV/AIDS Surveillance System (CDC, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP); State level available) Violent Crime Violent Crime: Number of murders, rapes, robberies, and aggravated assaults per 100,000 population. (FBI) LHI: Injuries and Violence- Homicide deaths (per 100,000): Homicide mortality rate. (National Vital Statistics System-Mortality (NVSS-M); National, state and county) Violent Crime: Number of murders, rapes, robberies, and aggravated assaults per 100,000 population. (FBI) Occupational Fatalities Occupational Fatalities: Number of fatalities from occupational injuries per 100,000 workers. (CFOI BLS) LHI: Injuries and Violence- Injury deaths (per 100,000): Injury death rate. ((NVSS-M); National, state and county level data) Infectious Disease Infectious Disease: Number of reported cases of measles, pertussis, syphilis and Hepatitis A per 100,000 population. (CDC MMWR) Children in Poverty Children in Poverty: % of persons under age 18 who live in households at or below the poverty threshold. (Census Bureau CPS) Children in Poverty: % of persons under age 18 who live in households at or below the federal poverty threshold. (Small Area Health Insurance Estimates) Pollution Air Air Pollution: Average exposure of the general public to particulate LHI: Environmental Quality-Number of days the Air Quality Index (AQI) 1. Air Pollution: Annual number of days that air quality was unhealthy for

3 3 of 7 matter of 2.5 microns or less in size (pm2.5). (EPA) exceeds 100 (number): Reduce the number of days the Air Quality Index (AQI) exceeds 100, weighted by population and AQI value, number. (AQS, EPA) sensitive populations due to fine particulate matter. (EPA) 2. Air Pollution- Ozone Days: Annual number of days that air quality was unhealthy for sensitive populations due to fine ozone concentration. (EPA) (Community Multi-Scale Air Quality Model (CMAQ) was also used to fill in data gaps) Built Environment Unemployment Rate Family and Social Support Unemployment Rate: Underemployment Rate: 1. Limited Access to Healthy Food: % of the population living with limited access to healthy foods. (U.S. Department of Agriculture Food Environment Atlas) 2.Fast Food Restaurants: % of restaurants in a county which are classified as fast-food by the County Business Patterns. (County Business Patterns) 3. Access to Recreational Facilities: Recreational facilities per 100,000 population in the county. (USDA Food Environment Atlas) Unemployment Rate: the annual average unemployment rat4e (U-3). This measure includes those age 16 and older. (Bureau of Labor Statistics Local Area Unemployment Statistics (LAUS)) 1.Lack of Adequate Social/Emotional Support-% of adults without social/emotional support. (BRFSS) 2.Children in Single-Parent Households- % of children living in family households that are raised by a single parent. (ACS)

4 4 of 7 Policy: Lack of Health Insurance Lack of Health Insurance: % of the population that does not have health insurance privately, through their employer, or the government. (Census Bureau CPS) LHI: Access to Health Services-Health insurance: <65 years (percent): % of persons under age 65 years with health (medical) insurance. (NHIS) Uninsured Rate: % of population under age 65 without health insurance. (Census Bureau s Small Area Health Insurance Estimates (SAHIE)) Policy: Public Health Funding Public Health Funding: State funding dedicated to public health as well as federal funding directed to states by the CDC and HRSA. (TFAH) Policy: Immunization Coverage Immunization Coverage: Avg. % of children ages 19 to 35 months who have received these individual vaccinations; four or more doses of DTP, three or more doses of poliovirus vaccine, one or more doses of any measles-containing vaccine, and three or more doses of HepB vaccine. (CDC NIP) LHI: Clinical Prevention Services-Complete Vaccination: children months (percent): % of children aged 19 to 35 months who receive the recommended doses of DTaP, polio, MMR, Hib, hepatitis B, varicella and PCV. (NIS) Clinical Care: Birthweight Low Low Birthweight: % of babies weighing less than 2,500grams (5pounds, 8 ounces) at birth. (CDC NCHS) LHI: Maternal, Infant, and Child Health-Preterm births, total (percent):% of live births that are preterm (< 37 weeks of gestation). (NVSS-N; National, State, and County Data) Low Birthweight: % of babies weighing less than 2,500grams( 5pounds, 8 ounces) at birth. (CDC NCHS) Clinical Care: Primary Care Physicians Primary Care Physicians: Number of primary care physicians (including general practice, family practice, OB-GYN, pediatrics, and internal medicine) per 100,000 population. (AMA) LHI: Access to Health Services: Usual primary care provider (percent)- % of persons with a usual primary care provider. (Medical Expenditure Panel Survey (MEPS)) Primary Care Physicians: ratio of population in a county to primary care physicians in a county (i.e., the number of people per primary care physician). (HRSA compiles data from AMA and from the Census Population Estimates program)

5 5 of 7 Clinical Care: Oral Health Care System Use Annual Dental Visit: LHI: Oral Health: Oral health care system use (percent)-% of children, adolescents, and adults who used the oral health care system in the past year. (Medical Expenditure Panel Survey (MEPS)) Clinical Care: Preventable Hospitalizations Preventable Hospitalizations: Discharge rate among the Medicare population for diagnoses that are amenable to non-hospital based care. (Dartmouth Atlas) Preventable Hospitalizations: Discharge rate among the Medicare population for diagnoses that are amenable to non-hospital based care. (Dartmouth Atlas) Clinical Care: Clinical Prevention Services Cholesterol Check: LHI: Clinical Prevention Services-Colorectal cancer screening: persons years (percent):% of adults who receive a colorectal cancer screening based on the most recent guidelines. (NHIS, CDC, NCHS) 1. Mammogram Rate: % of female Medicare enrollees age having at least one mammogram over a two-year period. (Dartmouth Atlas) 2. Diabetic Screening Rate: % of diabetic Medicare enrollees that receive HbA1c screening. (Dartmouth Atlas) Diabetes Diabetes: % of population over age 18 who have been told by a health professional that they have diabetes (does not include pre-diabetes or diabetes during pregnancy). (BRFSS) LHI: Clinical Preventive Services-Glucose A1c > 9%: adults with diabetes (percent)- % of adults with diagnosed diabetes with an HbA1c value greater than 9%. (NHANES) Blood Pressure Control High Blood Pressure: LHI: Clinical Preventive Services- Blood pressure control: adults with hypertension (percent):% of adults with hypertension whose blood pressure is under control. (NHANES) Poor Mental Health Days Poor Mental Health Days: Number of days in the previous 30 days when a person indicates their activities were limited due to mental health difficulties. LHI: Mental Health- Major depressive episode: teens (percent): Percent of adolescents aged 12 to 17 years with Major Depressive Episode. (National Survey on Drug Poor Mental Health Days: Number of days in the previous 30 days when a person indicates their activities were limited due to mental health difficulties. (BRFSS)

6 6 of 7 (BRFSS) Use and Health (NSDUH). (SAMHSA) Suicide Deaths Suicide Rate: LHI: Mental Health- Suicide deaths (per 100,000): Suicide death rate per 100,000 population. (NVSS-M; National, State and County) Poor Physical Health Days Geographic Disparity Poor Physical Health Days: Number of days in the previous 30 days when a person indicates their activities were limited due to physical health difficulties. (BRFSS) Geographic Disparity: Variation in overall mortality rates among the counties within a state. (CDC NCHS) 1. Poor Physical Health Days: Number of days in the previous 30 days when a person indicates their activities were limited due to physical health difficulties. (BRFSS) 2. Poor or Fair Health: % of adults reporting fair or poor health. (BRFSS) Infant Mortality Cardiovascular Deaths Cancer Deaths Infant Mortality: Number of infant deaths (before age 1) per 1,000 live births. (CDC NCHS) Cardiovascular Deaths: Number of deaths due to all cardiovascular diseases including heart disease and strokes, per 100,000 population. (CDC NCHS) Cancer Deaths: Number of deaths due to all causes of cancer per 100,000 population. (CDC NCHS) LHI: Maternal, Infant, and Child Health-Infant deaths, all (per 1,000 live births): Rate of all infant deaths (within 1 year). (NVSS-N; National, State, and County Data)

7 7 of 7 Premature Deaths Premature Death: Number of years of potential life lost prior to age 75 per 100,000 population. (CDC NCHS) Premature Death: Number of years of potential life lost prior to age 75 per 100,000 population. (CDC NCHS)