Health status in Tennessee counties, 2010-2013: Progress or stagnation?

Introduction: Where we live and play matters to our health. This symbiotic relationship has been established for many years. The County Health Rankings and Roadmaps, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, provides a useful opportunity to continue to test this relationship and the unhealthiest counties continue to be in the southern and southwestern United States.  Tennessee ranks among the least healthy.  How much have the ordinal rankings of Tennessee counties changed in the four years that the Health Rankings have been published annually?

Objective: This study examines premature death (mortality) and its related factors in Tennessee’s ninety-five counties for evidence of progress or stagnation over the four years that the Health Rankings have been published.

Methodology:  The County Health Rankings measure a particular county’s health status against a set of health factors or health status predictors, all reported as z scores. This study looks at the mortality (premature death) outcome in Tennessee’s ninety-five counties, against the weighted average scores of four predictive factors (behavior, clinical care, SES and the built environment) from 2010-2013. It examines two elements of the weighted average scores of each of the four factors examined by the County Health Rankings, for a total of eight independent variables, using a multiple regression model and a persistence model.

Expected Result: A priori, we predict the existence of persistence or stagnation in each county’s health status from 2010 to 2013.