Online Program

Relative contributions of health determinants on health outcomes at the county level

Monday, November 4, 2013 : 8:30 a.m. - 8:50 a.m.

Hyojun Park, MA, Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI
Anne Roubal, MS, Department of Population Health Sciences, University of Wisconsin, Madison, WI
Barbara Rudolph, Ph.D., Population Health Institute at University of Wisconsin, Madison, WI
Bridget Booske Catlin, PhD, 517 WARF Building, Department of Population Health Sciences, Madison, WI
Objectives: Several theoretical models have been proposed to quantify the relative impact of specific health determinants on related health outcomes. Yet, no consensus has been established for the relative contribution of various health factors. This study aims to estimate the relative effect of health determinants categorized into health behaviors, clinical care, social and economic factors, and physical environment, on health outcomes.

Methods: Data from four consecutive years (2010-2013) of the County Health Rankings for approximately 3,000 U.S. counties were used in the analysis. Structural equation modeling was utilized to estimate the relative contribution of each construct on health outcomes and to evaluate the validity and reliability of models. Sensitivity analyses were conducted to address potential variations of the estimates.

Results: The estimated contributions were similar to the weighting scheme applied in the Rankings: health behaviors (30%), clinical care (20%), social and economic factors (40%), and the physical environment (10%). With the exception of the physical environment, high levels of validity and reliability were found for the constructs of mortality, morbidity, health behaviors, clinical care, and social and economic factors.

Conclusions: The estimated relative contributions of health factors on health outcomes were consistent with the Rankings model. Our findings provide robust empirical evidence to enrich discussion about models of population health and could be used to help policy makers prioritize limited resources to improve community health.

Learning Areas:

Public health or related research

Learning Objectives:
Describe different theoretical population health models and their implications. Describe the four health factors of the County Health Rankings and how they are associated with selected health outcomes. Discuss the implications of the various contributions of different health factors in selecting health improvement strategies.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been working on the County Health Rankings since its inception, I am a PhD student in Population Health Sciences and one of my research interests is to provide empirical evidence to test theoretical population health models.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.