Findings Social And Economic Factors | 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

Alabama

2022 Annual Report – Executive Brief 2022 Annual Report 2022 Annual Report – State Summaries 2022 Annual Report – Economic Hardship Index County-Level Maps 2022 Annual Report – Measures Table 2022 Annual Report – Infographics 2022 Annual Report – Report Data (All States)

SOCIAL and ECONOMIC FACTORS | Community and Family Safety
Firearm deaths increased, with disparities by race/ethnicity that worsened during the pandemic.
Firearm Deaths
The U.S. has seen an uptick in firearm deaths over the last decade. In 2020, there were more than 45,000 deaths by gun violence, the highest number ever recorded. Additionally, firearm deaths surpassed motor vehicle accidents as the leading cause of death among children — a concerning trend for U.S. communities.
Changes over time. Nationally, the firearm death rate — deaths due to firearm injury of any intent (unintentional, suicide, homicide or undetermined) per 100,000 population — significantly increased 13% from 12.1 to 13.7 between 2019 and 2020. In 2020, 45,222 people in the U.S. died due to firearm injury, an increase of 5,515 people since 2019. The firearm death rate significantly increased in 18 states, led by 33% in Kentucky (15.3 to 20.3 deaths per 100,000 population), 32% in New York (4.1 to 5.4) and 29% in Illinois (10.8 to 13.9). Most racial/ethnic, gender and age groups experienced significant increases in the firearm death rate, including:
35% among Black (23.4 to 31.5), 32% among American Indian/Alaska Native (13.4 to 17.7), 18% among Hispanic (6.5 to 7.7) and 3% among white (11.6 to 12.0) populations.
13% among males (21.3 to 24.1) and 12% among females (3.4 to 3.8).
28% among those ages 15-24 (17.4 to 22.2), 25% among those 25-34 (18.1 to 22.7) and 14% among those 35-44 (14.6 to 16.7).
Disparities. The firearm death rate was 8.0 times higher in Mississippi (28.0 deaths per 100,000 population) than in Hawaii (3.5), the states with the highest and lowest rates in 2020. The rate significantly varied by race/ethnicity, gender and age. It was: 
12.1 times higher among Black (31.5) compared with Asian (2.6) populations.
6.3 times higher among males (24.1) than females (3.8).
2.1 times higher among those ages 25-34 (22.7) than those 65-74 (10.9). Those ages 15-24 (22.2) also had a high rate.*
COVID-era impact by race/ethnicity. The disparity in the firearm death rate between the Black and Asian populations — the populations with the highest and lowest rates, respectively — widened between 2019 and 2020. The rate was 9.0 times higher among Black (23.4 deaths per 100,000 population) compared with Asian (2.6) populations in 2019, and 12.1 times higher among Black (31.5) compared with Asian (2.6) populations in 2020.

SOCIAL and ECONOMIC FACTORS | Economic Resources
Economic hardship index measures of unemployment and poverty have worsened since the beginning of the COVID-19 pandemic, while the percentage of adults with less than a high school education and per capita income improved.
Economic Hardship Index

The economic hardship index compares economic conditions among communities. The measure combines six population-level social and economic measures, providing a more comprehensive picture of the economic difficulties faced in a community than a single measure could provide.
Changes over time. Economic conditions that worsened nationally between 2019 and 2021 include unemployment (40% increase from 4.5% to 6.3%), poverty (5% increase from 12.2% to 12.8%) and crowded housing (3% increase from 3.3% to 3.4%). Economic measures that improved include the percentage of adults ages 25 and older with less than a high school education (7% decrease from 11.4% to 10.6%) and per capita income (7% increase from $35,672 to $38,332). Changes in all subcomponents of the index were significant, except dependency, the percentage of the population ages 0-17 or 65 and older.
Disparities. The economic hardship index score was highest in Louisiana (100) and New Mexico and Mississippi (both 99); scores were lowest in New Hampshire (1), Colorado (18) and Vermont (23) in 2021. A higher score indicates worse economic conditions.
Related Measure: Income Inequality (80:20 Ratio)
Changes over time. Nationally, income inequality — the ratio of median household income at the 80th percentile to median household income at the 20th percentile — significantly increased 2% from 4.85 to 4.96 between 2019 and 2021.

SOCIAL and ECONOMIC FACTORS | Education
The first pandemic-era education data show a drop in reading proficiency. Racial/ethnic disparities in fourth grade reading proficiency have widened.
Fourth Grade Reading Proficiency
Fourth grade reading proficiency is an important indicator of educational development. By the time children reach fourth grade, they are expected to be able to read in order to learn other subjects. If children are not proficient in reading by this age, it becomes harder for them to succeed academically.
Changes over time. Nationally, the percentage of fourth grade public school students who scored proficient or above on the reading assessment decreased 6% from 34.3% to 32.1% between 2019 and 2022. The percentage decreased 10% or more in 23 states and the District of Columbia, led by 26% in West Virginia (30.3% to 22.3%), 22% in Delaware (32.5% to 25.3%) and 19% in Maine (36.0% to 29.2%). Over the same period, the rate increased in four states, led by 10% in Louisiana (25.7% to 28.3%). The percentage decreased 9% among Hispanic (22.6% to 20.5%), 8% among both Black (17.6% to 16.2%) and white (44.4% to 41.0%), and 7% among American Indian/Alaska Native (19.8% to 18.5%) students, while increasing 1% among Asian/Pacific Islander students (54.5% to 55.3%).
Disparities. Fourth grade reading proficiency was 2.0 times higher in Massachusetts (42.6%) than in New Mexico (21.0%), the states with the highest and lowest percentage in 2022.
COVID-era impact by race/ethnicity. The disparity in fourth grade reading proficiency between Asian/Pacific Islander and Black students — the groups with the highest and lowest rates, respectively — widened between 2019 and 2022. The percentage was 3.1 times higher among Asian/Pacific Islander (54.5%) compared with Black (17.6%) students in 2019, and 3.4 times higher among Asian/Pacific Islander (55.3%) compared with Black (16.2%) students in 2022. 

SOCIAL and ECONOMIC FACTORS | Social Support and Engagement
Food insecurity and high-speed internet have improved. Racial/ethnic disparities in high-speed internet have narrowed.
Food Insecurity
Food insecurity is a complex problem and does not exist in isolation. Many food-insecure families also struggle with disadvantages resulting from structural racism, lack of affordable housing, high medical costs and low wages. Food insecurity has broad effects on health due to the mental and physical stress it places on the body.
Changes over time. Nationally, the percentage of households unable to provide adequate food for one or more household members due to lack of resources significantly decreased 11% from 11.7% to 10.4% between 2016-2018 and 2019-2021, and has decreased 29% (from 14.6%) since 2011-2013. Food insecurity significantly decreased 28% in Indiana (13.5% to 9.7%) between 2016-2018 and 2019-2021. 
Disparities. Food insecurity was 2.8 times higher in Mississippi (15.3%) than in New Hampshire (5.4%), the states with the highest and lowest prevalence in 2019-2021.
High-speed Internet
Lack of access to high-speed internet has recently been identified as a social determinant of health. Having high-speed internet access has been especially crucial during the COVID-19 pandemic, as many employers and educators have transitioned to remote work and learning.  Moreover, having high-speed internet is vital for receiving health care via telehealth.
Changes over time. Nationally, the percentage of households with a broadband internet subscription and a computer, smartphone or tablet significantly increased 3% from 89.4% to 92.4% between 2019 and 2021. High-speed internet access increased in all 50 states, led by 6% in both New Mexico (81.4% to 86.4%) and Arkansas (84.1% to 88.9%). Nearly all racial/ethnic groups experienced significant increases in high-speed internet access.
Disparities. High-speed internet access was 1.1 times higher in Washington and Utah (both 95.2%) than in Mississippi (85.2%), the states with the highest and lowest prevalence in 2021.
COVID-era impact by race/ethnicity. The disparity in high-speed internet access between Asian and American Indian/Alaska Native households — the groups with the highest and lowest prevalence, respectively — narrowed from 17.0 percentage points to 9.8 percentage points between 2019 and 2021. The American Indian/Alaska Native rate increased 11% (77.9% to 86.3%) and the Asian rate increased 1% (94.9% to 96.1%). 



* The values of the two highest groups were not significantly different from each other based on non-overlapping 95% confidence intervals.