Social Determinants of Health

The focus on social determinants has increasingly become the focus of health care decision making. The use of non-clinical data has implications for the likelihood of health care access, patient adherence to medication, and safety (Health Research & Educational Trust, 2017). For example, in 2015, the Institute of Medicine released a report that provides recommendations for specific social determinants of health that should be captured within electronic health record systems and has also been integrated into the Quality Payment Program (Adler & Stead, 2015, Feller et al., 2020). More recently, Healthy People 2020 released four overarching goals for the decade, which included social determinants of health and the specific goal to “provide social and physical environments that promote good health for all.” Social determinants of health include factors such as socioeconomic and behavioral factors, including factors such as income, social engagement, and substance abuse. Disparities in education and income are identified as indicators for early health intervention (Probst & Ajmal, 2019). Now backed by resources (CDC, 2020), continuing into the future there will be a focus on using social determinants to address health care quality, equity, efficiency, and cost.

Analyzing the Data

The purpose of this analysis is to compare health status and health conditions with social determinants of health by examining the rates of self-reported mental distress given population estimates, poverty rates, overall health status, and reported drug use at the county level.

This data is also available in a text-based table format.

Tutorial: Using the Data

Data Sources

County Health Ranking (data released 2020)

Note: Because the number of events for an indicator may be too small to report for a county for any single year, data were aggregated over several years (3, 5 or 10 years depending on county population) for the measures of birth and death to increase the number of counties with available data. Data was aggregated for counties that have a population size less than 25,000 from years 1996-2005. Counties with a population between 25,000 and 99,999 include data that was aggregated from years 2001-2005. Finally, counties that have a population size greater than 100,000 include data that was aggregated from years 2003-2005. Death rates were age-adjusted to the year 2000 standard calculated by the Health Resources and Services Administration. Mortality data were from the National Center for Health Statistics, National Vital Statistics System, 1996–2005 for the ICD-9/ICD-10 codes listed after each variable.

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 U.S. Census Bureau's list of 2019 FIPS Codes for Counties and County Equivalent Entities.

Population Size: The total number of individuals residing in the county. This data is a mid-year estimate of resident population for 2018.

Children in Poverty Rate: The percentage of children under age 18 living in poverty. Poverty status is defined by family; either everyone in the family is in poverty or no one in the family is in poverty. Data is from the Small Area Income Poverty Estimates (SAIPE) in 2018.

Frequent Mental Distress Rate: The percentage of adults who reported ≥14 days in response to the question, "Now, thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?" Data is from the Behavioral Risk Factor Surveillance System (BRFSS) survey in 2017.

Excessive Drinking Rate: The percentage of adults that report either binge drinking, defined as consuming more than 4 (women) or 5 (men) alcoholic beverages on a single occasion in the past 30 days, or heavy drinking, defined as drinking more than one (women) or 2 (men) drinks per day on average. Data is from the Behavioral Risk Factor Surveillance System (BRFSS) survey in 2017.

Rate of Poor or Fair Health: The percentage of adults aged 18 years and older who report "fair" or "poor" overall health. The measure is provided by the Behavioral Risk Factor Surveillance System (BRFSS) survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2017.

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,560,000 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.