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Executive BriefForewordIntroductionNational HighlightsFindingsHealth OutcomesSocial and Economic FactorsPhysical EnvironmentClinical CareState RankingsInternational ComparisonCOVID-era Disparities SurveyAppendixMeasures TableData Source DescriptionsMethodologyState SummariesAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingUS Summary
SOCIAL AND ECONOMIC FACTORS
Community and Family Safety
Firearm Deaths*
Deaths due to firearm injury of any intent (unintentional, suicide, homicide, or undetermined) per 100,000 population.
CDC WONDER, Multiple Cause of Death Files, 2020
Occupational Fatalities
Number of fatal occupational injuries in construction, manufacturing, trade, transportation and utility industries as well as professional and business services per 100,000 workers.
U.S. Bureau of Labor Statistics, Census of Fatal Occupational Injuries, 2018-2020
Public Health Funding‡
State dollars dedicated to public health per person (including federal grants directed to states from the Centers for Disease Control and Prevention and the Health Resources & Services Administration).
CDC, HRSA and Trust for America's Health, 2019-2020
Violent Crime‡
Number of murders, rapes, robberies and aggravated assaults per 100,000 population.
Federal Bureau of Investigation, Uniform Crime Reporting Program, 2020
Economic Resources
Economic Hardship Index
Index of state economic conditions based on crowded housing, dependency, education, income, poverty and unemployment; normalized values are 1 to 100, with a higher value indicating worse economic conditions.
U.S. Census Bureau, American Community Survey, 2021
Crowded Housing*
Percentage of occupied housing units with more than one person per room.
U.S. Census Bureau, American Community Survey, 2021
Dependency*
Percentage of population ages 0-17 or 65 and older.
U.S. Census Bureau, American Community Survey, 2021
Less Than High School Education*
Percentage of population ages 25 and older without a high school diploma.
U.S. Census Bureau, American Community Survey, 2021
Per Capita Income*
Per capita income in the past 12 months, in inflation-adjusted dollars to data year.
U.S. Census Bureau, American Community Survey, 2021
Poverty*
Percentage of households living below the federal poverty level.
U.S. Census Bureau, American Community Survey, 2021
Unemployment*
Percentage of civilian workforce ages 16-64 that are unemployed.
U.S. Census Bureau, American Community Survey, 2021
Food Insecurity
Percentage of households unable to provide adequate food for one or more household members due to lack of resources.
U.S. Department of Agriculture, Household Food Security in the United States Report, 2019-2021
Homeownership*
Percentage of housing units owned by the occupant.
U.S. Census Bureau, American Community Survey, 2021
Homeownership Racial Disparity*
Difference between the homeownership rates of the white population and the racial/ethnic population with the lowest rate (varies by state).
U.S. Census Bureau, American Community Survey, 2021
Income Inequality
Ratio of median household income at the 80th percentile to median household income at the 20th percentile (80:20 ratio).
U.S. Census Bureau, American Community Survey, 2021
Education
Fourth Grade Reading Proficiency
Percentage of fourth grade public school students who scored proficient or above on the National Assessment of Educational Progress in reading comprehension.
U.S. Department of Education, National Center for Education Statistics, National Assessment of Educational Progress, 2022
High School Completion*
Percentage of adults ages 25 and older with at least a high school diploma or equivalent.
U.S. Census Bureau, American Community Survey, 2021
High School Graduation‡
Percentage of high school students graduating with a regular high school diploma within four years of starting ninth grade.
U.S. Department of Education, National Center for Education Statistics, Common Core of Data, 2018-2019 School Year
High School Graduation Racial Disparity‡
Difference between the high school graduation rates of white students and the racial/ethnic group with the lowest rate (varies by state).
U.S. Department of Education, National Center for Education Statistics, Common Core of Data, 2018-2019 School Year
Social Support and Engagement
Adverse Childhood Experiences^
Percentage of children ages 0-17 who have ever experienced two or more of the following: parental divorce or separation; living with someone who had an alcohol or drug problem; neighborhood violence victim or witness; living with someone who was mentally ill, suicidal or severely depressed; domestic violence witness; parent served jail time; being treated or judged unfairly due to race/ethnicity; or death of a parent.
U.S. HHS, HRSA, Maternal and Child Health Bureau, National Survey of Children's Health, 2020-2021
High-speed Internet
Percentage of households with a broadband internet subscription and a computer, smartphone or tablet.
U.S. Census Bureau, American Community Survey, 2021
Residential Segregation - Black/White
Index of dissimilarity, with higher values indicating greater segregation between Black and non-Hispanic white households, ranging from zero (complete integration) to 100 (complete segregation).
U.S. Census Bureau, American Community Survey, 2016-2020
Volunteerism‡
Percentage of population ages 16 and older that reported volunteering in the past 12 months.
U.S. Census Bureau, Current Population Survey, Volunteering and Civic Life Supplement, 2019
Voter Participation (Average)‡,^
Average of the percentage of U.S. citizens ages 18 and older who voted in the last presidential and the last midterm national elections.
U.S. Census Bureau, Current Population Survey, Voting and Registration Supplement, 2018/2020
PHYSICAL ENVIRONMENT
Air and Water Quality
Air Pollution
Average exposure of the general public to particulate matter of 2.5 microns or less, measured in micrograms per cubic meter.
U.S. EPA, 2019-2021
Drinking Water Violations‡
Percentage of population served by community water systems with a serious drinking water violation during the year.
U.S. EPA, Enforcement and Compliance History Online, Safe Drinking Water Information System, 2021
Non-smoking Regulation*
Percentage of population covered by 100% smokefree laws for restaurants, bars and non-hospitality workplaces.
American Nonsmokers' Rights Foundation, 2022
Risk-screening Environmental Indicator Score
Estimated human health-related risk from exposure to toxic chemicals based on emission data of more than 600 chemicals, with higher scores denoting elevated risk.
U.S. EPA, Toxic Release Inventory National Analysis, 2020
Water Fluoridation‡
Percentage of population served by community water systems that have fluoridated water.
CDC, Water Fluoridation Reporting System, 2018
Climate Change
Climate Change Policies*
Number of the following state policies in place: legally binding electricity portfolio standards, carbon pricing policies, climate change action plans and economy-wide greenhouse gas emission targets.
Center for Climate and Energy Solutions, 2021
Transportation Energy Use*
Amount of energy (in trillion British thermal units) consumed by the transportation of people and goods per 100,000 population.
U.S. Energy Information Administration, State Energy Data System, 2020
Housing and Transit
Drive Alone to Work
Percentage of workers ages 16 and older who drive alone to work
U.S. Census Bureau, American Community Survey, 2021
Housing With Lead Risk
Percentage of housing stock with potential elevated lead risk due to age of housing.
U.S. Census Bureau, American Community Survey, 2021
Severe Housing Problems
Percentage of occupied housing units with at least one of the following problems: lack of complete kitchen facilities, lack of plumbing facilities, overcrowding or severely cost-burdened occupants.
U.S. Department of Housing and Urban Development, Comprehensive Housing Affordability Strategy, 2015-2019
CLINICAL CARE
Access to Care
Avoided Care Due to Cost
Percentage of adults who reported a time in the past 12 months when they needed to see a doctor but could not because of cost.
CDC, Behavioral Risk Factor Surveillance System, 2021
Providers
Dental Care Providers
Number of general dentists and advanced practice dental therapists per 100,000 population.
U.S. HHS, Centers for Medicare & Medicaid Services, National Plan and Provider Enumeration System, 2022
Mental Health Providers
Number of psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists and advanced practice nurses specializing in mental health care per 100,000 population.
U.S. HHS, Centers for Medicare & Medicaid Services, National Plan and Provider Enumeration System, 2022
Primary Care Providers
Number of active primary care providers (including general practice, family practice, obstetrics and gynecology, pediatrics, geriatrics, internal medicine, physician assistants and nurse practitioners) per 100,000 population.
U.S. HHS, Centers for Medicare & Medicaid Services, National Plan and Provider Enumeration System, 2022
Uninsured
Percentage of population not covered by private or public health insurance.
U.S. Census Bureau, American Community Survey, 2021
Preventive Clinical Services
Colorectal Cancer Screening‡
Percentage of adults ages 50-75 who reported receiving one or more of the recommended colorectal cancer screening tests within the recommended time interval (blood stool test within the past year, sigmoidoscopy within the past five years, colonoscopy within the past 10 years, stool DNA test within the past three years, virtual colonoscopy within the past five years or sigmoidoscopy within the past 10 years and blood stool test in the past year).
CDC, Behavioral Risk Factor Surveillance System, 2020
Dental Visit‡
Percentage of adults who reported visiting a dentist or dental clinic within the past year.
CDC, Behavioral Risk Factor Surveillance System, 2020
Immunizations
Childhood Immunizations
Percentage of children who received by age 24 months all recommended doses of the combined seven-vaccine series: diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine; measles, mumps and rubella (MMR) vaccine; poliovirus vaccine; Haemophilus influenzae type b (Hib) vaccine; hepatitis B (HepB) vaccine; varicella vaccine; and pneumococcal conjugate vaccine (PCV).
CDC, National Immunization Survey-Child, 2018-2020
Flu Vaccination
Percentage of adults who reported receiving a seasonal flu vaccine in the past 12 months.
CDC, Behavioral Risk Factor Surveillance System, 2021
HPV Vaccination
Percentage of adolescents ages 13-17 who received all recommended doses of the human papillomavirus (HPV) vaccine.
CDC, National Immunization Survey-Teen, 2021
Quality of Care
Dedicated Health Care Provider
Percentage of adults who reported having a personal doctor or health care provider.
CDC, Behavioral Risk Factor Surveillance System, 2021
Preventable Hospitalizations
Discharges following hospitalization for ambulatory care sensitive conditions (PQI 90) per 100,000 Medicare beneficiaries ages 18 and older enrolled in the fee-for-service program.
U.S. HHS, Centers for Medicare & Medicaid Services, Office of Minority Health, Mapping Medicare Disparities Tool, 2020
BEHAVIORS
Nutrition and Physical Activity
Exercise‡
Percentage of adults who met the federal physical activity guidelines (150 minutes of moderate or 75 minutes of vigorous aerobic activity and two days of muscle strengthening per week) in the past 30 days.
CDC, Behavioral Risk Factor Surveillance System, 2019
Fruit and Vegetable Consumption
Percentage of adults who reported consuming two or more fruits and three or more vegetables daily.
CDC, Behavioral Risk Factor Surveillance System, 2021
Physical Inactivity
Percentage of adults who reported doing no physical activity or exercise other than their regular job in the past 30 days.
CDC, Behavioral Risk Factor Surveillance System, 2021
Chlamydia
Number of new cases of chlamydia per 100,000 population.
CDC, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Atlas, 2020
High-risk HIV Behaviors‡
Percentage of adults who reported any of the following in the past year: injected any drug other than those prescribed for you; treated for a sexually transmitted disease; or given or received money or drugs in exchange for sex.
CDC, Behavioral Risk Factor Surveillance System, 2020
Teen Births
Births per 1,000 females ages 15-19.
CDC WONDER, Natality Public Use Files, 2020
Insufficient Sleep‡
Percentage of adults who reported sleeping, on average, fewer than seven hours in a 24-hour period.
CDC, Behavioral Risk Factor Surveillance System, 2020
Smoking and Tobacco Use
E-cigarette Use*
Percentage of adults who reported using e-cigarettes or other electronic vaping products at least once in their lifetime and now use daily or some days.
CDC, Behavioral Risk Factor Surveillance System, 2021
Smoking
Percentage of adults who reported smoking at least 100 cigarettes in their lifetime and currently smoke daily or some days.
CDC, Behavioral Risk Factor Surveillance System, 2021
HEALTH OUTCOMES
Behavioral Health
Drug Deaths*
Deaths due to drug injury (unintentional, suicide, homicide or undetermined) per 100,000 population.
CDC WONDER, Multiple Cause of Death Files, 2020
Excessive Drinking
Percentage of adults who reported binge drinking (four or more [females] or five or more [males] drinks on one occasion in the past 30 days) or heavy drinking (eight or more [females] or 15 or more [males] drinks per week).
CDC, Behavioral Risk Factor Surveillance System, 2021
Frequent Mental Distress
Percentage of adults who reported their mental health was not good 14 or more days in the past 30 days.
CDC, Behavioral Risk Factor Surveillance System, 2021
Non-medical Drug Use - Past Year^
Percentage of adults who reported using prescription drugs non-medically (including pain relievers, stimulants and sedatives) or illicit drugs (excluding cannabis) in the last 12 months.
Denver Health and Hospital Authority, RADARS® System Survey of Non-Medical Use of Prescription Drugs Program, 2022
Suicide*
Deaths due to intentional self-harm per 100,000 population.
CDC WONDER, Multiple Cause of Death Files, 2020
Mortality
Premature Death
Years of potential life lost before age 75 per 100,000 population.
CDC WONDER, Multiple Cause of Death Files, 2020
Premature Death Racial Disparity
Ratio of the premature death rate of the racial/ethnic group with the highest rate (varies by state) to that of the non-Hispanic white population.
CDC WONDER, Multiple Cause of Death Files, 2018-2020
Physical Health
Frequent Physical Distress
Percentage of adults who reported their physical health was not good 14 or more days in the past 30 days.
CDC, Behavioral Risk Factor Surveillance System, 2021
High Health Status*
Percentage of adults who reported that their health was very good or excellent.
CDC, Behavioral Risk Factor Surveillance System, 2021
Low Birthweight
Percentage of infants weighing less than 2,500 grams (5 pounds, 8 ounces) at birth.
CDC WONDER, Natality Public Use Files, 2020
Low Birthweight Racial Disparity
Ratio of the low birthweight rate of the racial/ethnic group with the highest rate (varies by state), and the low birthweight rate of the non-Hispanic white population.
CDC WONDER, Natality Public Use Files, 2018-2020
Multiple Chronic Conditions
Percentage of adults who had three or more of the following chronic health conditions: arthritis, asthma, chronic kidney disease, chronic obstructive pulmonary disease, cardiovascular disease (heart disease, heart attack or stroke), cancer (excluding skin), depression and diabetes.
CDC, Behavioral Risk Factor Surveillance System, 2021
Arthritis*
Percentage of adults who reported ever being told by a health professional that they had some form of arthritis.
CDC, Behavioral Risk Factor Surveillance System, 2021
Asthma*
Percentage of adults who reported being told by a health professional that they currently have asthma.
CDC, Behavioral Risk Factor Surveillance System, 2021
Cancer*
Percentage of adults who reported ever being told by a health professional that they had any form of cancer other than skin cancer.
CDC, Behavioral Risk Factor Surveillance System, 2021
Cardiovascular Diseases*
Percentage of adults who reported ever being told by a health professional that they had angina or coronary heart disease; a heart attack or myocardial infarction; or a stroke.
CDC, Behavioral Risk Factor Surveillance System, 2021
Chronic Kidney Disease*
Percentage of adults who reported ever being told by a health professional that they have kidney disease (excluding kidney stones, bladder infection or incontinence).
CDC, Behavioral Risk Factor Surveillance System, 2021
Chronic Obstructive Pulmonary Disease*
Percentage of adults who reported ever being told by a health professional that they have chronic obstructive pulmonary disease, emphysema or chronic bronchitis.
CDC, Behavioral Risk Factor Surveillance System, 2021
Depression*
Percentage of adults who reported ever being told by a health professional that they have a depressive disorder, including depression, major depression, minor depression or dysthymia.
CDC, Behavioral Risk Factor Surveillance System, 2021
Diabetes*
Percentage of adults who reported ever being told by a health professional that they have diabetes (excluding prediabetes and gestational diabetes).
CDC, Behavioral Risk Factor Surveillance System, 2021
Risk Factors
High Blood Pressure*
Percentage of adults who reported being told by a health professional that they had high blood pressure.
CDC, Behavioral Risk Factor Surveillance System, 2021
High Cholesterol*
Percentage of adults who reported having their cholesterol checked and being told by a health professional that it was high.
CDC, Behavioral Risk Factor Surveillance System, 2021
Obesity
Percentage of adults with a body mass index of 30.0 or higher based on reported height and weight.
CDC, Behavioral Risk Factor Surveillance System, 2021
DEMOGRAPHICS
Total Population*
Number of estimated residents.
CDC WONDER, Single-Race Population Estimates, 2021
Population - Children Ages <18*
Percentage of population younger than age 18.
CDC WONDER, Single-Race Population Estimates, 2021
Population - Adults Ages 18-64*
Percentage of population ages 18-64.
CDC WONDER, Single-Race Population Estimates, 2021
Population Ages 65+*
Percentage of population ages 65 and older.
CDC WONDER, Single-Race Population Estimates, 2021
Rural Population*
Percentage of a state’s total population estimated to live in a rural area.
U.S. Census Bureau, 2020
* Not included in the calculation of overall, model category or topic summation measures.
‡ Data in this edition were repeated from the last edition.