title: Improving the environmental quality component of the County Health Rankings model.
abstract: OBJECTIVE
  We examined the association between environmental quality measures and health outcomes by using the County Health Rankings data, and tested whether a revised environmental quality measure for 1 state could improve the models.
  
  
  METHODS
  We conducted state-by-state, county-level linear regression analyses to determine how often the model's 4 health determinants (social and economic factors, health behaviors, clinical care, and physical environment) were associated with mortality and morbidity outcomes. We then developed a revised measure of environmental quality for West Virginia, and tested whether the revised measure was superior to the original measure.
  
  
  RESULTS
  Measures of social and economic conditions, and health behaviors, were related to health outcomes in 58% to 88% of state models; measures of environmental quality were related to outcomes in 0% to 8% of models. In West Virginia, the original measure of environmental quality was unrelated to any of the 8 health outcome measures, but the revised measure was significantly related to all 8.
  
  
  CONCLUSIONS
  The County Health Rankings model underestimates the impact of the physical environment on public health outcomes. Suggestions for other data sources that may contribute to improved measurement of the physical environment are provided.
authors: Department of Community Medicine, West Virginia University, Morgantown, WV 26506, USA. mhendryx@hsc.wvu.edu
authors: Michael
authors: M
authors: Hendryx
authors: Melissa M
authors: MM
authors: Ahern
authors: Keith J
authors: KJ
authors: Zullig
mesh_terms: D004777:Environment; D006305:Health Status Indicators; D006801:Humans; D016014:Linear Models; D017063:Outcome Assessment, Health Care; D011634:Public Health; D012307:Risk Factors; D014481:United States; D014903:West Virginia