Socioeconomic Status and Well-being

Research has demonstrated a persisting association between socioeconomic status, health status, and mortality rates (Evans et al., 2016, Gennuso, 2019). Health disparities are significantly related to factors such as education, race, ethnicity, and occupation (Adler & Cutler, 2016Henning-Smith et al., 2019), and studies continue to identify a relationship between social determinants of health and health outcomes (Chapman, 2010, Rubin, 2016).

Analyzing the Data

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

Tutorial: Using the Data

Data Sources

County Health Ranking (data released 2020)

Dartmouth Health Atlas - Medicare Reimbursements/Enrollee (data released 2017)

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 2019 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 2014 through 2018.

Median Household Income: Median annual household income. Data is from the Small Area Income and Poverty Estimates (SAIPE) in 2018.

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 2014 through 2018.

Percent Diabetes: The percentage of patients with diabetes. The reporting period for this measure is 2016 from the Centers for Disease Control and Prevention (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 2017 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 2016 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 2016 through 2018 from CDC Wide-ranging ONline Data for Epidemiologic Research (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 2017.

Total Medicare Reimbursements: Total Medicare reimbursements per enrollee adjusted for price, age, sex, and race. The reporting period for this measure is 2017.

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 2017.

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 2017.

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 2017.

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 2017.

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 2017.

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 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, $1,009,121 (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.