Health Ranking of the Largest US Counties Using the Community Health Status Indicators Peer Strata and Database

OBJECTIVE: Using the structure of the Community Health Status Indicators (CHSI) report, we embarked on analysis of population health data with the aim to validate the CHSI modules as overarching themes and to rank county health within peer strata. DESIGN, SETTING, PARTICIPANTS: Ranking was conducted for the largest (>100 000), nonfrontier counties (county aggregates) (N = 508) in the United States for many aspects of population health. Factor analysis was used to assess CHSI modularity and analyses of variance confirmed peer strata homogeneity. MAIN OUTCOME MEASURES: Ten factors were identified. They were life stage, injury, cancer, adult behaviors, preventive services, environment-food, and health care access. Because they did not contribute to a factor, 4 CHSI summary health measures (all-cause mortality, average life expectancy, health status, and unhealthy days) were also ranked. RESULTS: No single factor emerged as reflecting overall county health. CONCLUSIONS: Further summary of county health will be challenging. We present the ranks for CHSI peer strata #1, local jurisdictions of 1 million or greater population. County factor content and data availability may differ when counties of smaller size are considered. Ranking may be utilized by community leaders for community health assessment and local priority setting, and ultimately incorporated into CHSI Web-based reports.