Introduction

Executive Brief IntroductionKey FindingsSocial and Economic Factors Physical Environment Clinical Care Behaviors Health OutcomesState Summaries

Alabama

US SummaryAppendixMeasures Table Data Source Descriptions The Team

2021 Senior Report – Executive Brief 2021 Senior Report 2021 Senior Report – State Summaries 2021 Senior Report – County-Level Maps for Risk of Social Isolation 2021 Senior Report – Report Data (All States)

Introduction
The America’s Health Rankings© Senior Report, now in its ninth year, provides a portrait of the health and well-being of older adults in the U.S., capturing key trends, successes and challenges in order to spark meaningful dialogue and action to improve senior health across the nation and on a state-by-state basis.
More than 54 million adults ages 65 and older live in the United States today, according to the U.S. Census Bureau — accounting for about 16.5% of the nation’s population. The number of older adults living in the U.S. is large and growing; by 2050, the total number of adults ages 65 and older is projected to rise to an estimated 85.7 million — roughly 20% of the overall U.S. population. Thus, it is essential that policymakers, community leaders and public health officials consider how to best safeguard and improve the health of older Americans.
While the older adult population is growing across the nation, they make up a much larger share of the population in some states than in others. In 2019, Maine had the highest proportion of adults ages 65 and older (21.2%) and Utah had the lowest (11.4%). No matter the size of the senior population, every state had strengths and challenges when examining the measures in this report. It is important to consider all the measures collectively, as each measure does not stand alone but rather influences and is influenced by other measures of health and everyday life. As the U.S. demographics change, the United Health Foundation is committed to providing actionable data and insights on the health needs of older Americans. 
Impact of COVID-19
This past year has illuminated the growing health concerns seniors face amid the COVID-19 pandemic. According to the Centers for Disease Control and Prevention (CDC), the pandemic has claimed the lives of nearly 450,000 seniors across the country as of May 5, 2021 — around 80% of all U.S. COVID-19 related deaths — and affected countless others. Adults ages 65 and older are at increased risk of hospitalization or death from COVID-19. Further, the pandemic has disproportionately affected certain racial and ethnic groups, reflecting some of the longstanding disparities that persist in many of the measures included in the Senior Report.
Provisional death data released by the CDC in March 2021 showed a 16% increase in the age-adjusted premature death rate between 2019 and 2020. This was the first recorded increase in the premature death rate, an important measure of a population’s health, since 2017. The provisional estimates placed COVID-19 as the third-leading cause of death in 2020, behind heart disease and cancer. Older adults accounted for most deaths due to COVID-19, with the highest death rates among those ages 85 and older.
Out of the shared understanding that the country is facing significant and unprecedented health challenges due to COVID-19, America’s Health Rankings has chosen not to include overall state rankings in this year’s Senior Report. Instead, we aim to equip health leaders with data and insights that can inform their priorities as they manage public health needs during this unprecedented time. We are, however, still including rankings for individual measures so leaders can continue to benchmark their state's progress on key health indicators.
The data in this report are compiled from many different sources and referenced by the year the data were collected. This allows readers to determine which measures were collected before the COVID-19 pandemic and which measures were collected during the pandemic. This approach is intended to clarify lags that are present in the data, ensuring that public health and community leaders have the most accurate picture of health in their communities. 
While the Senior Report uses the most recent data that is publicly available for each measure, the majority of the measures in the report leverage data from 2019 and thus may serve as a baseline for the health of older Americans prior to the COVID-19 pandemic. The impact of the pandemic across numerous health measures will likely be reflected in the 2022 Senior Report as data collected in 2020 and 2021 are released. 
The America’s Health Rankings website contains state-by-state and national data for COVID-19 case rates, death rates, Medicare claims case rates and hospitalization rates, as well as vaccination rates for the total population and adults ages 65 and older.
Purpose
America’s Health Rankings’ purpose is to inform and drive action to build healthier communities by offering credible, trusted data for improving health and health care. The Senior Report uses 22 data sources including the Centers for Medicare & Medicaid Services Office of Minority Health’s Mapping Medicare Disparities Tool, the CDC’s Behavioral Risk Factor Surveillance System as well as the U.S. Census Bureau’s American Community Survey and Current Population Survey to produce:
49 measures that track current and emerging health issues at the state and national level, including two demographic measures.
Five categories that comprise the rankings model: social and economic factors, physical environment, clinical care, behaviors and health outcomes.
15 topics that group related measures, such as behavioral health, within a model category. 
Nine years of data for measures included in the first Senior Report released in 2013.
To improve population health, the America’s Health Rankings Senior Report:
Presents a holistic view of health. This report goes beyond measures of clinical care and considers social, economic and physical environment measures to reflect the growing understanding of the impact of social determinants on health.
Provides a benchmark for states. Each year the report renders trends, strengths, challenges and highlights for every state. Community leaders, public health workers and policymakers can monitor health trends over time and compare their state with neighboring states and the nation.
Stimulates action. The report is intended to drive change and improve health by promoting data-driven discussions among individuals, community leaders, the media, policymakers and public health workers. States can incorporate the report into their annual review of programs, and many organizations use the report as a reference when assigning goals for health-improvement plans.
Highlights disparities. The report shows differences in health between states and among population groups at the state and national level, with groupings based on gender, race and ethnicity, education and income. Health disparities must be addressed in order to achieve health equity.
This year’s report was developed in partnership with the Gerontological Advanced Practice Nurses Association (GAPNA). The United Health Foundation is pleased to partner with GAPNA because of the valuable role that advanced practice nurses have continue to play in promoting the health and well-being of America’s seniors, including during the COVID-19 pandemic. As front-line clinicians, advanced practice nurses are active across the continuum of care, working in primary, acute, post-acute and long-term care to improve the health of seniors every day. The mission of the United Health Foundation — to enhance the well-being of our communities — closely aligns with GAPNA’s goal of advocating for quality care for older adults.

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