title: County Health Rankings: Relationships Between Determinant Factors and Health Outcomes.
abstract: BACKGROUND
  The County Health Rankings (CHR) provides data for nearly every county in the U.S. on four modifiable groups of health factors, including healthy behaviors, clinical care, physical environment, and socioeconomic conditions, and on health outcomes such as length and quality of life. The purpose of this study was to empirically estimate the strength of association between these health factors and health outcomes and to describe the performance of the CHR model factor weightings by state.
  
  
  METHODS
  Data for the current study were from the 2015 CHR. Thirty-five measures for 45 states were compiled into four health factors composite scores and one health outcomes composite score. The relative contributions of health factors to health outcomes were estimated using hierarchical linear regression modeling in March 2015. County population size; rural/urban status; and gender, race, and age distributions were included as control variables.
  
  
  RESULTS
  Overall, the relative contributions of socioeconomic factors, health behaviors, clinical care, and the physical environment to the health outcomes composite score were 47%, 34%, 16%, and 3%, respectively. Although the CHR model performed better in some states than others, these results provide broad empirical support for the CHR model and weightings.
  
  
  CONCLUSIONS
  This paper further provides a framework by which to prioritize health-related investments, and a call to action for healthcare providers and the schools that educate them. Realizing the greatest improvements in population health will require addressing the social and economic determinants of health.
authors.affiliation: Population Health Institute, University of Wisconsin-Madison, Madison, Wisconsin. Electronic address: chood@wisc.edu.
authors.forename: Carlyn M
authors.initials: CM
authors.lastname: Hood
authors.affiliation: Population Health Institute, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Keith P
authors.initials: KP
authors.lastname: Gennuso
authors.affiliation: Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Wisconsin Center for Health Equity, Milwaukee, Wisconsin.
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Swain
authors.affiliation: Population Health Institute, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Bridget B
authors.initials: BB
authors.lastname: Catlin
mesh_terms: D004777:Environment; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008136:Longevity; D011787:Quality of Health Care; D011788:Quality of Life; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology