Appendix Methodology | 2022 Annual Report

Executive Brief Foreword Introduction National HighlightsFindingsHealth Outcomes Social and Economic Factors Physical Environment Clinical Care State Rankings International Comparison COVID-era Disparities SurveyAppendixMeasures Table Data Source Descriptions MethodologyState Summaries

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The 2022 Annual Report includes 83 individual measures developed from 29 data sources. For each measure, the most recently available state-level data as of November 1, 2022 are presented as the value. For a full list of measures, definitions and source details, see the 2022 Annual Report Appendix. Significance is based on non-overlapping 95% confidence intervals when comparing data over time or across demographic subpopulations. New measures available in this year’s report include firearm deaths and high school completion.
The state health rankings are a summation of select state-level population health measures. Data for 12 of the 51 measures used in the ranking calculation were repeated from the 2021 edition as no new data were available. Ranking methodology, measures and weights as well as measure changes based on input from an Advisory Committee throughout recent Annual Report history are described under Model and Methodology.
Florida data are missing from the national values for measures from the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS), as the state was unable to collect data to meet CDC's minimum requirements for inclusion in the 2021 annual aggregate data set. Also in 2019, New Jersey did not meet CDC’s minimum requirements for inclusion in the BRFSS annual aggregate data set.
COVID-era impact analysis by race/ethnicity, spotlighted in this special edition, was assessed by investigating all measures with race/ethnicity data to determine if there were significant changes between before the pandemic (2019 and earlier) and the most recent data available. For measures with significant changes by race/ethnicity, disparity ratios (highest value divided by the lowest value) were calculated and compared to determine if the disparity had widened or narrowed. Absolute differences were also compared.
Subpopulation Group Definition
Subpopulation analyses are performed to illuminate age, gender, race and ethnicity, education, income and metropolitan status disparities. Not all subpopulations are available for all data sources and measures. Individual estimates are suppressed if they do not meet the reliability criteria laid out by the data source or by established internally. Some values have wide confidence intervals, meaning that the true value may by far from the estimate listed.
Data are provided where available for the following racial and ethnic groups: American Indian/Alaska Native, Asian, Black or African American (labeled as Black), Hispanic or Latino (labeled as Hispanic), Native Hawaiian or Other Pacific Islander (labeled as Hawaiian/Pacific Islander), white, multiracial and/or those who identify as other race. Ethnicity was collected separately on surveys. People who identified as Hispanic or Latino may be of any race. Of note, racial groups are collected differently across data sources. For example, some sources combined Asian and Pacific Islander while other sources differentiated Asian from Native Hawaiian and Other Pacific Islander. In most data provided, the racial and ethnic groups are mutually exclusive, meaning all racial groups were non-Hispanic.
COVID-19 Data
A few measures highlighted in this year’s report come from America’s Health Rankings COVID-19 Data. These data include 17 measures developed from seven sources with data related to COVID-19 deaths, vaccinations, booster doses, long COVID and pandemic-related life disruptions. Most COVID-19 data were updated with each 2022 America’s Health Rankings state-level report publication (May, October, December). COVID-19 Data and source details can be found on the America’s Health Rankings website. Long COVID data presented are from the September 14-26, 2022 Phase 3.6 of the U.S. Census Bureau’s Household Pulse Survey.
COVID-era Disparities Survey
The COVID-era Disparities Survey was conducted by Morning Consult on behalf of the United Health Foundation to better understand the COVID-19 pandemic’s effect across racial and ethnic groups. The online non-probability survey was conducted from October 12-23, 2022 among U.S. adults 18 and older. Respondents were recruited to be on an internet panel from a variety of sources (web ads, mobile survey apps and survey walls, etc.) to minimize potential coverage error and were invited to participate in exchange for incentives. 
Statistical modeling was used to control for self-selection to create unbiased and representative samples independent of the initial recruitment process. First, a sampling frame was built for the population of interest based on publicly available data from the U.S. Census Bureau. Respondents were invited to participate based on mutually exclusive sampling strata based off of the sampling frame. This process (quota sampling) ensured that those asked to participate were representative of the non-institutionalized adult U.S. population on important demographic characteristics. For this study, quotas were filled based off the intersection of age and gender. Second, respondents were terminated from the sample if they did not meet requirements for attentiveness, credibility, speeding, straightlining and satisficing. Third, all respondents that passed the quality assurance process were then weighted using iterative proportional fitting (or raking) to the sampling frame to ensure they were representative on a broader set of demographic characteristics, including age, gender, race/ethnicity, education and U.S. census region.
Six independent samples were collected: one for the general population and separate samples for specific racial/ethnic groups. For comparison within the report, white non-Hispanic adults were a subset of the general population data. 
Sample sizes and margins of error (MOE):  
General population: n=1,000, MOE= +/- 3 percentage points
Hispanic adults: n=800, MOE= +/- 3 percentage points
Black adults: n=800, MOE= +/- 3 percentage points 
Asian American adults: n=800, MOE= +/- 3  percentage points  
American Indian/Alaska Native adults: n=250, MOE= +/- 6  percentage points
Native Hawaiian or Other Pacific Islander adults: n=199, MOE= +/- 7  percentage points
Each of the samples surveyed was weighted based on age, gender, race/ethnicity, education and region. Throughout the analysis, significance testing was run to identify significant differences across racial and ethnic groups. To test for statistically significant differences between responses, Morning Consult tested for the quality of proportions with an alpha level set at 0.05 (5%).

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