Appendix Methodology | 2023 Senior Report

Executive Brief Foreword Introduction National HighlightsFindingsHealth Outcomes Social and Economic Factors Clinical Care Behaviors State RankingsAppendixMeasures Table Data Source Descriptions MethodologyState Summaries

US Summary

2023 Senior Report – Executive Brief 2023 Senior Report 2023 Senior Report – State Summaries 2023 Senior Report – County-Level Maps for Risk of Social Isolation 2023 Senior Report – Measures Table 2023 Senior Report – Infographics 2023 Senior Report – Report Data (All States)

Individual Measures
This year, 52 measures were analyzed for the America’s Health Rankings 2023 Senior Report. For each measure, the most recent data available as of March 8, 2023 are presented. Data years varied by measure due to the variety of data sources. For some measures, multiple years of data were combined to ensure reliable state-level estimates. Measure definitions, sources and data years are available in the Appendix: Measures Table. Measure changes were based on input from an advisory committee.
Each state is ranked according to its value for each measure, with a rank of 1 assigned to the state with the healthiest value. Ties in value were assigned equal ranks. If a state value was not available for a measure in this edition, the state value was noted as unavailable or suppressed. 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 Americashealthrankings.org/about/page/submit-an-inquiry.
Overall, Model Category and Health Topic Summations
Summations were generated overall and by model category and health topic. They show how a state compared with other states for a model category, such as social and economic factors, or for a specific health topic, such as economic resources. 
Overall state rankings were based on 35 weighted measures that met the following criteria:
Represented issues that affect population health for seniors. 
Had data available at the state level. 
Used common measurement criteria across the 50 states.
Were current and updated periodically.
Were amenable to change. 
Score Calculation 
The state value for each measure was 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 was above or below the U.S. value. Scores were capped at +/- 2.00 to prevent an extreme score from excessively influencing the state’s overall score. If a U.S. value was not available from the original data source for a measure, the mean of all states and the District of Columbia was used. If a value was not available for a state, its value from the most recent available data year was used to generate a score.
Summation scores were 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, were multiplied by 1, while measures with a negative association, such as smoking and early death, were multiplied by -1. A state that ranks No. 1 has a higher summation score (e.g., 2.00), reflecting better health than a state that ranks No. 50 with a lower summation score (e.g., -2.00). Overall state rank was calculated by ranking the overall summation score, which included all 35 measures with weights in the model (see Measures, Weights and Direction for model and measure weights).
Data Notes 
Data presented in this report were 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 were updated on the America’s Health Rankings website to reflect known errors or updates from the reporting source.
Caution is suggested when interpreting data on certain health and behavioral measures. Many were self-reported and relied on an individual’s perception of health and behaviors. Additionally, some health outcome measures were based on respondents being told by a health care professional that they have a disease and exclude those who may not have received a diagnosis or sought or obtained treatment.
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, motor vehicle deaths and housing cost burden.
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.
Subpopulation Group Definitions
Subpopulation analyses were performed to illuminate disparities by gender, race/ethnicity, education, income and metropolitan status. Not all subpopulations were available for all data sources and measures. 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 value may be far from the estimate listed.
Education
Education data in this report were available for measures from BRFSS. BRFSS groupings were 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.
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 limit the ability to describe the health of transgender or gender nonbinary individuals. 
Income
Income data in this report were available for measures from BRFSS. BRFSS groupings were based on responses to the question, “[What] is your annual household income from all sources?” Responses of less than $10,000, less than $15,000 ($10,000 to less than $15,000), less than $20,000 ($15,000 to less than $20,000) and less than $25,000 ($20,000 to less than $25,000) were summed and classified as less than $25,000. Responses of less than $35,000 ($25,000 to less than $35,000) and less than $50,000 ($35,000 to less than $50,000) were summed and classified as $25-$49,999. Responses of less than $75,000 ($50,000 to less than $75,000) were classified as $50-$74,999. Responses of $75,000 or more were classified as $75,000 or more.
Metropolitan Status
Metropolitan status data in this report were available for measures from BRFSS. BRFSS groupings were coded based on residence geography. Identification as large central metro, large fringe metro, medium metro and small metro were classified as Metro, and identification as micropolitan and noncore were classified as Non-Metro.
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. Hispanic ethnicity includes members of all racial groups. Racial/ethnic groups were defined differently across data sources (details below). In summary, BRFSS and CDC WONDER race data are presented as non-Hispanic, while the American Community Survey and CMS Mapping Medicare Disparities Tool race data are presented as Hispanic-inclusive (except for white, which is non-Hispanic).
Race and ethnicity categories by source:
BRFSS: American Indian/Alaskan Native (non-Hispanic); Asian (non-Hispanic); Black or African American (non-Hispanic); Hispanic, Latino/a or Spanish origin (any race); Native Hawaiian or Other Pacific Islander (non-Hispanic); white (non-Hispanic); multiracial (non-Hispanic); and other race (non-Hispanic).
CDC WONDER: American Indian or Alaska Native (non-Hispanic); Asian (non-Hispanic); Black or African American (non-Hispanic); Hispanic (any race); Native Hawaiian or Other Pacific Islander (non-Hispanic); white (non-Hispanic); and more than one race (non-Hispanic).
American Community Survey: American Indian and Alaska Native; Asian; Black or African American; Hispanic or Latino Origin (any race); Native Hawaiian or Other Pacific Islander; white (non-Hispanic); two or more races; and some other race.
CMS, Mapping Medicare Disparities Tool: American Indian/Alaska Native; Asian/Pacific Islander; Black or African American; Hispanic (any race); and white (non-Hispanic).

Methodology

Individual Measures

Overall, Model Category and Health Topic Summations

Score Calculation

Data Notes

Subpopulation Group Definitions

Reports

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