Appendix Methodology | 2024 Senior Report

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

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2024 Senior Report 2024 Senior Report – Executive Brief 2024 Senior Report – State Summaries 2024 Senior Report – Risk of Social Isolation County-Level Maps 2024 Senior Report – Measures Table 2024 Senior Report – Infographics 2024 Senior Report – Report Data (All States)

Individual Measures
This year, 52 measures (including 35 weighted and 17 additional measures) were analyzed for the America’s Health Rankings 2024 Senior Report, using the most recent data available as of March 4, 2024. Final mortality data were added on April 3, 2024. Data years varied by measure because of the variety of data sources. Multiple data years were combined for some measures 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 the Advisory Committee and are detailed in the 2024 Senior Report Measures Selection and Changes webpage.
Each state was 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, it was noted as unavailable or suppressed. 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.
How State Rankings Were Generated
Summations were generated overall and by model category. Summations show how a state compares with other states for a model category, such as social and economic factors or overall. 
Overall state rankings were based on 35 weighted measures that met the following criteria:
Represented issues that affect population health. 
Had data available at the state level. 
Used common measurement criteria across the 50 states.
Were current and updated periodically.
Were amenable to change. 
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 ranked No. 1 had a higher summation score (e.g., 2.00), reflecting better health than a state that ranked No. 50 with a lower summation score (e.g., -2.00). The 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).
Scores and ranks were not calculated for the District of Columbia because of its unique status as an entirely urban population with different governing and funding mechanisms than states. While the District of Columbia was not included in the rankings, its data are available in this report and on the America’s Health Rankings website.
Data Notes & Limitations
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 and updates from the reporting source. 
Use caution 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 are based on respondents being told by a health care professional that they have a disease and may exclude those who have not 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. 
Demographic Group Definitions
Demographic analyses were performed to illuminate disparities by age, disability status, education, gender, sexual orientation, income, metropolitan status, race/ethnicity and veteran status. Not all demographic groups 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 internally established criteria. Some values had wide 95% confidence intervals, meaning the true value may be far from the estimate listed.
Age. Age data in this report were available for measures from CDC WONDER and included the following age ranges: 65-74, 75-84 and 85 and older. 
Disability Status. Disability status data in this report were available for measures from BRFSS. Groupings were based on responses to the questions in the core disability section: “Are you deaf or do you have serious difficulty hearing?”, “Are you blind or do you have serious difficulty seeing, even when wearing glasses?”, “Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?”, “Do you have serious difficulty walking or climbing stairs?”, “Do you have difficulty dressing or bathing?” and “Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping?” Responses of no or missing to all questions, with at least one response being no, were coded as without a disability.
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?”
Gender. This report stratified gender as men and women but acknowledges that not all people identify as belonging to one of 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 and nonbinary individuals, especially at the state level.
Sexual Orientation. Sexual orientation data in this report were available for measures from BRFSS. Groupings were based on responses to the question, “Which of the following best represents how you think of yourself?” Responses of lesbian or gay, gay, bisexual or something else were summed and classified as LGBQ+. Responses of straight, that is, not gay were summed and classified as straight. 
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?”
Metropolitan Status. Metropolitan status data in this report were available for measures from BRFSS. Groupings were coded based on the respondents’ residence. Identification as large central metro, large fringe metro, medium metro or small metro was classified as metropolitan, and identification as micropolitan and noncore was classified as non-metropolitan. 
Race/Ethnicity. Data were provided where available for the following racial and ethnic groups: American Indian/Alaska Native, Asian, Black or African American (classified in this report as Black), Hispanic or Latino/a (classified as Hispanic), Native Hawaiian or Other Pacific Islander (classified as Hawaiian/Pacific Islander), white, multiracial and those who identify as other race. Hispanic ethnicity includes members of all racial groups. BRFSS and CDC WONDER race groupings are all non-Hispanic, while American Community Survey and CMS Mapping Medicare Disparities Tool race groupings are Hispanic-inclusive, except for white, which is non-Hispanic.
Veteran Status. Veteran status data in this report were available for measures from BRFSS. Groupings were based on responses to the question, “Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit?”

Methodology

Individual Measures

How State Rankings Were Generated

Data Notes & Limitations

Demographic Group Definitions

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