title: Health ranking of the largest US counties using the Community Health Status Indicators peer strata and database.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. nkanarek@jhsph.edu
authors.forename: Norma
authors.initials: N
authors.lastname: Kanarek
authors.forename: Hua-Ling
authors.initials: HL
authors.lastname: Tsai
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stanley
mesh_terms: D000367:Age Factors; D016208:Databases, Factual / Q000706:statistics & numerical data; D004777:Environment; D015438:Health Behavior; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006306:Health Surveys / Q000706:statistics & numerical data; D006801:Humans; D009369:Neoplasms / Q000453:epidemiology; D011314:Preventive Health Services / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D017062:Small-Area Analysis; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology