Socioeconomic Status and Well-being

Research has demonstrated an association between socioeconomic status and health status (Evans et al., 2016). Studies have identified a relationship between a variety of social and environmental factors, oftentimes called social determinants of health and health outcomes (Rubin, 2016). Health disparities are significantly related to factors such as education, race, ethnicity and occupation (Adler & Cutler, 2016).

The purpose of this analysis is to explore health-related outcomes (including diabetes rates, premature mortality rates, health care costs, preventable hospital stays and poor mental health days) in relationship to a variety of social determinants of health, including median household income, food insecurity and race at the county level.

This scenario includes benchmarks for each appropriate variable. State-level benchmarks are accessible by filtering by state. Scenarios with multiple outcome variables require filtering by the specific outcome to return the corresponding benchmarks.

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Tutorial: Using the Data

Data Sources

County Health Ranking (data released 2017)

Dartmouth Atlas (data released 2016)

Defining the Columns

A blank entry indicates unreported data. A value of zero is a defined value and does not represent unreported data.

State: The abbreviated name of the state where the county is located.

County: The name of the county where the information was collected. County names are listed as provided on the US Census Bureau's list of 2010 FIPS Codes for Counties and County Equivalent Entities.

Income Inequality Rate: Ratio of household income at the 80th percentile to income at the 20th percentile. Data is from the American Community Survey from 2011 through 2015.

Median Household Income: Median annual household income. Data is from the Small Area Income and Poverty Estimates (SAIPE) in 2015.

Percent Residential Segregation Black/White: The percentage of either black or white residents that would have to move to different geographic areas in order to produce a distribution that matches that of the larger area. A lower value is desired. The value ranges from zero (complete integration) to 100 (complete segregation) and is from the American Community Survey from 2011 through 2015.

Percent Diabetes: The percentage of patients with diabetes. The reporting period for this measure is 2013 from the CDC Diabetes Interactive Atlas.

Percent Food Insecurity: The percentage of the population that lack access, at times, to enough food for an active, healthy life for all household members and limited or uncertain availability of nutritionally adequate foods. The reporting period for this measure is 2014 from Map the Meal Gap.

Percent Limited Access to Healthy Foods: The percentage of the population that have limited access to supermarkets, supercenters, grocery stores or other sources of healthy and affordable food may make it harder for some Americans to eat a healthy diet. The reporting period for this measure is 2010 from USDA Food Environment Atlas.

Premature Age Adjusted Mortality per 100,000: Number of deaths among residents under age 75 per 100,000 population (age-adjusted). The reporting period for this measure is 2013 through 2015 from CDC WONDER mortality data.

Preventable Hospital Stays per 1,000: The hospital discharge rate for ambulatory care-sensitive conditions per 1,000 fee-for-service Medicare enrollees. The reporting period for this measure is 2014.

Total Medicare Reimbursements: Total Medicare reimbursements per enrollee adjusted for price, age, sex and race. The reporting period for this measure is 2014.

Hospital and Skilled Nursing Facility Reimbursements: Reimbursement for hospital and skilled nursing facility per enrollee adjusted for price, age, sex and race. The reporting period for this measure is 2014.

Physician Reimbursements: Reimbursement of physician services per enrollee adjusted for price, age, sex and race as determined from actual Medicare claims data. The reporting period for this measure is 2014.

Outpatient Facility Reimbursements: Reimbursement of outpatient facility services per enrollee adjusted for price, age, sex and race as determined from actual Medicare claims data. The reporting period for this measure is 2014.

Home Health Agency Reimbursements: Reimbursement of home health agency services per enrollee adjusted for price, age, sex and race as determined from actual Medicare claims data. The reporting period for this measure is 2014.

Hospice Reimbursements: Reimbursement of hospice services per enrollee adjusted for price, age, sex and race as determined from actual Medicare claims data. The reporting period for this measure is 2014.

Durable Medical Equipment Reimbursements: Reimbursement of durable medical equipment per enrollee adjusted for price, age, sex and race as determined from actual Medicare claims data. The reporting period for this measure is 2014.

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Tutorial: Using Excel Output