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

The Community Health Status Indicator (CHSI) report provides an assessment of population health, reporting on categories including: behavioral risk factors, health care access, and environmental health. This article examines the validity of the CHSI indicators to rank county health within peer strata.

Using 2008 CHSI data, the study includes 508 non-frontier U.S. counties of 100,000 or more population. Counties were ranked on each factor within the peer stratum: life stage, injury, cancer, adult behaviors, preventive services, environment-food, and health care access. Also, all-cause mortality, average life expectancy, health status and unhealthy days—four CHSI summary health measures—were also ranked.

Factors were validated for most CHSI modules. Additionally, the peer stratum predicted a portion of the variance among all factors; therefore, it is considered an appropriate ranking group for comparison.

While additional data may improve specific factors, the authors found that no single factor emerged as reflecting overall county health. Going forward, these findings could help communities that feel they have more in common with peers than with surrounding counties in their state.