Modeling area-level health rankings

Charles Courtemanche, Samir Soneji, Rusty Tchernis

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Objective Rank county health using a Bayesian factor analysis model. Data Sources Secondary county data from the National Center for Health Statistics (through 2007) and Behavioral Risk Factor Surveillance System (through 2009). Study Design Our model builds on the existing county health rankings (CHRs) by using data-derived weights to compute ranks from mortality and morbidity variables, and by quantifying uncertainty based on population, spatial correlation, and missing data. We apply our model to Wisconsin, which has comprehensive data, and Texas, which has substantial missing information. Data Collection Methods The data were downloaded from Principal Findings Our estimated rankings are more similar to the CHRs for Wisconsin than Texas, as the data-derived factor weights are closer to the assigned weights for Wisconsin. The correlations between the CHRs and our ranks are 0.89 for Wisconsin and 0.65 for Texas. Uncertainty is especially severe for Texas given the state's substantial missing data. Conclusions The reliability of comprehensive CHRs varies from state to state. We advise focusing on the counties that remain among the least healthy after incorporating alternate weighting methods and accounting for uncertainty. Our results also highlight the need for broader geographic coverage in health data.

Original languageEnglish
Pages (from-to)1413-1431
Number of pages19
JournalHealth Services Research
Issue number5
StatePublished - Oct 1 2015

Bibliographical note

Publisher Copyright:
© Health Research and Educational Trust.


  • Bayesian
  • County
  • factor analysis
  • health
  • rank

ASJC Scopus subject areas

  • Health Policy


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