Appendix Methodology | 2022 Senior Report

Executive Brief Introduction 10-Year National HighlightsFindingsMortality Behavioral Health Physical Health Immunizations Smoking and Tobacco Use Social Support and Engagement State Rankings National SummaryState Summaries

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US SummaryAppendixMeasures Table Data Source Descriptions Methodology

2022 Senior Report – Executive Brief 2022 Senior Report 2022 Senior Report – State Summaries 2022 Senior Report - County-Level Maps for Risk of Social Isolation 2022 Senior Report – Infographics 2022 Senior Report – Measures Table 2022 Senior Report – Report Data (All States)

Individual Measures
Forty-eight measures were analyzed for the Senior Report. For each measure, the most recent state-level data available as of March 17, 2022 are presented as the value. Due to the variety of sources, data years varied by measure. For some measures, multiple years of data were combined to ensure reliable state-level estimates.
The ranking is the ordering of each state according to its value for each measure, with a rank of 1 assigned to the healthiest value. Ties in value were assigned equal ranks. If a state value was not available for a measure in this edition, its value from the most recent data year available was used or the state value was left empty. It is important to note that rankings are a relative measure of health. Not all changes in rank translate into actual declines or improvements in health. For additional methodology information, submit an inquiry at Submit an Inquiry.
Overall, Model Category and Health Topics
Summations were generated overall and by model category and health topic. They showed how a state compared to other states for a specific topic, such as economic resources, or a category, such as social and economic factors. Overall state rankings were based on 37 weighted measures in the model that met the following criteria:
Represent issues that affect population health.
Have data available at the state level.
Use common measurement criteria across the 50 states.
Are current and updated periodically.
Are amenable to change.
Calculation of Summation Measure Rankings
The state value for each measure is normalized into a z-score, hereafter referred to as score, using the following formula:
The score indicates the number of standard deviations a state value is above or below the U.S. value. Scores are capped at +/- 2.00 to prevent an extreme score from excessively influencing the state’s overall score. If a U.S. value is not available from the original data source for a measure, the mean of all states and the District of Columbia is used. If a value is not available for a state, it is assigned a score of zero.
Summation scores are calculated by adding the products of the score for each measure multiplied by that measure’s assigned model weight and association with health. Measures positively associated with population health, such as volunteerism and flu vaccination, are multiplied by 1, while measures with a negative association, such as smoking and early death, are multiplied by -1. A state that ranks No. 1 will have a higher summation score (e.g., 2.000), reflecting better health than a state that ranks No. 50 with a lower summation score (e.g., -2.000). Overall state rank is the ranking of the overall summation score, which includes all 37 measures with weights in the model (see Measures, Weights and Directions for model and measure weights).
Data Notes
The overall state rankings resumed with the 2022 Senior Report after being excluded in the 2020 and 2021 Senior Reports due to the public health challenges presented by the COVID-19 pandemic.
The pandemic created data collection challenges in 2020 for many surveys, including the U.S. Census Bureau’s American Community Survey (ACS) and the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS). Due to poor response rates in 2020, the Bureau is not releasing its standard 2020 ACS estimates. As a result, 2019 ACS data were repeated in this year’s Senior Report. For BRFSS, all states met the minimum requirements to be included in the public-use data set for 2020. However, there were interruptions to data collection in some areas due to the pandemic. Initial shortfalls in data collection were made up for by the end of the data collection period. The anomaly in data collection timing could lead to some differences in seasonal estimates such as flu vaccination, but estimates are still considered comparable to prior year estimates.
Data presented in this report are aggregated at the state level and cannot be used to make inferences at the individual level. Additionally, estimates cannot be extrapolated beyond the population upon which they were created. Values and ranks from prior years are updated on the America’s Health Rankings website to reflect known errors or updates from the reporting source. When available, estimates were compared within subpopulation groups and over time to ascertain whether differences were statistically significant at the 95% confidence interval threshold.
Caution is suggested when interpreting data on certain health and behavioral measures. Many are self-reported and rely on an individual’s perception of health and behaviors. Additionally, some health outcome measures indicate whether respondents have been told by a health care professional that they have a disease, excluding those who may not have received a diagnosis or sought or obtained treatment.

Subpopulation Group Definitions
Subpopulation analyses were conducted to illuminate disparities by age, gender, race and ethnicity, education and income as well as metro/non-metro areas. Not all subpopulations were available for all data sources and measures. In addition, definitions may have varied, particularly for race and ethnicity. Individual estimates were suppressed if they did not meet the reliability criteria laid out by the data source or by internally established criteria. Some values had wide confidence intervals, meaning that the true rate may have been far from the estimate listed.
Gender
This report includes data for females and males as available through public data sources even though not all people identified with these two categories. Data did not differentiate between assigned sex at birth and current gender identity. While sex and gender influence health, the current data collection practices of many national surveys limited our ability to describe the health of transgender or gender nonbinary individuals.
Race and Ethnicity
Data were provided where available for the following racial and ethnic groups: American Indian/Alaska Native, Asian, Black or African American (labeled in this report as Black), Hispanic or Latino (labeled in this report as Hispanic), Native Hawaiian or Other Pacific Islander (labeled in this report as Hawaiian/Pacific Islander), white, multiracial and those who identify as other race. Ethnicity was collected separately from race. People who identified as Hispanic or Latino may be of any race.
Racial groups were defined differently across data sources. For example, some sources combined Asian and Pacific Islander while other sources differentiated Asian from Hawaiian and Other Pacific Islander. In most data provided, the racial and ethnic groups were mutually exclusive, meaning all racial groups were non-Hispanic.
Education
Education data in this report were only available for measures from the Behavioral Risk Factor Surveillance System (BRFSS). Groupings are based on responses to the question, “What is the highest grade or year of school you completed?” A response of grades 9 through 11 (some high school) was classified as less than high school; a response of grade 12 or GED (high school graduate) was classified as high school or GED; a response of college 1 year to 3 years (some college or technical school) was classified as some post-high school; and a response of college 4 years or more (college graduate) was classified as college graduate.

Methodology

Individual Measures

Overall, Model Category and Health Topics

Calculation of Summation Measure Rankings

Data Notes

Subpopulation Group Definitions

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