Identifying characteristics of high-poverty counties in the United States with high well-being: an observational cross-sectional study
Objective To identify county characteristics associated with high versus low well-being among high-poverty counties.Design Observational cross-sectional study at the county level to investigate the associations of 29 county characteristics with the odds of a high-poverty county reporting population...
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e035645.full |
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| author | Jeph Herrin Harlan M Krumholz Carley Riley Brita Roy Anita Arora Elizabeth Y Rula Erica S Spatz Kenneth Patton Kell |
| author_facet | Jeph Herrin Harlan M Krumholz Carley Riley Brita Roy Anita Arora Elizabeth Y Rula Erica S Spatz Kenneth Patton Kell |
| author_sort | Jeph Herrin |
| collection | DOAJ |
| description | Objective To identify county characteristics associated with high versus low well-being among high-poverty counties.Design Observational cross-sectional study at the county level to investigate the associations of 29 county characteristics with the odds of a high-poverty county reporting population well-being in the top quintile versus the bottom quintile of well-being in the USA. County characteristics representing key determinants of health were drawn from the Robert Wood Johnson Foundation County Health Rankings and Roadmaps population health model.Setting Counties in the USA that are in the highest quartile of poverty rate.Main outcome measure Gallup-Sharecare Well-being Index, a comprehensive population-level measure of physical, mental and social health. Counties were classified as having a well-being index score in the top or bottom 20% of all counties in the USA.Results Among 770 high-poverty counties, 72 were categorised as having high well-being and 311 as having low well-being. The high-well-being counties had a mean well-being score of 71.8 with a SD of 2.3, while the low-well-being counties had a mean well-being score of 60.2 with a SD of 2.8. Among the six domains of well-being, basic access, which includes access to housing and healthcare, and life evaluation, which includes life satisfaction and optimism, differed the most between high-being and low-well-being counties. Among 29 county characteristics tested, six were independently and significantly associated with high well-being (p<0.05). These were lower rates of preventable hospital stays, higher supply of primary care physicians, lower prevalence of smoking, lower physical inactivity, higher percentage of some college education and higher percentage of heavy drinkers.Conclusions Among 770 high-poverty counties, approximately 9% outperformed expectations, reporting a collective well-being score in the top 20% of all counties in the USA. High-poverty counties reporting high well-being differed from high-poverty counties reporting low well-being in several characteristics. |
| format | Article |
| id | doaj-art-8b0f5660960f49c8ba904ecadff99e9d |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-8b0f5660960f49c8ba904ecadff99e9d2025-01-06T13:15:08ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2019-035645Identifying characteristics of high-poverty counties in the United States with high well-being: an observational cross-sectional studyJeph Herrin0Harlan M Krumholz1Carley Riley2Brita Roy3Anita Arora4Elizabeth Y Rula5Erica S Spatz6Kenneth Patton Kell7Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA2 Center for Outcomes & Evaluation (CORE), Yale University School of Medicine, New Haven, Connecticut, USADepartment of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USADepartment of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USADepartment of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA7 Tivity Health, Franklin, Tennessee, USA1 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USATivity Health, Franklin, Tennessee, USAObjective To identify county characteristics associated with high versus low well-being among high-poverty counties.Design Observational cross-sectional study at the county level to investigate the associations of 29 county characteristics with the odds of a high-poverty county reporting population well-being in the top quintile versus the bottom quintile of well-being in the USA. County characteristics representing key determinants of health were drawn from the Robert Wood Johnson Foundation County Health Rankings and Roadmaps population health model.Setting Counties in the USA that are in the highest quartile of poverty rate.Main outcome measure Gallup-Sharecare Well-being Index, a comprehensive population-level measure of physical, mental and social health. Counties were classified as having a well-being index score in the top or bottom 20% of all counties in the USA.Results Among 770 high-poverty counties, 72 were categorised as having high well-being and 311 as having low well-being. The high-well-being counties had a mean well-being score of 71.8 with a SD of 2.3, while the low-well-being counties had a mean well-being score of 60.2 with a SD of 2.8. Among the six domains of well-being, basic access, which includes access to housing and healthcare, and life evaluation, which includes life satisfaction and optimism, differed the most between high-being and low-well-being counties. Among 29 county characteristics tested, six were independently and significantly associated with high well-being (p<0.05). These were lower rates of preventable hospital stays, higher supply of primary care physicians, lower prevalence of smoking, lower physical inactivity, higher percentage of some college education and higher percentage of heavy drinkers.Conclusions Among 770 high-poverty counties, approximately 9% outperformed expectations, reporting a collective well-being score in the top 20% of all counties in the USA. High-poverty counties reporting high well-being differed from high-poverty counties reporting low well-being in several characteristics.https://bmjopen.bmj.com/content/10/9/e035645.full |
| spellingShingle | Jeph Herrin Harlan M Krumholz Carley Riley Brita Roy Anita Arora Elizabeth Y Rula Erica S Spatz Kenneth Patton Kell Identifying characteristics of high-poverty counties in the United States with high well-being: an observational cross-sectional study BMJ Open |
| title | Identifying characteristics of high-poverty counties in the United States with high well-being: an observational cross-sectional study |
| title_full | Identifying characteristics of high-poverty counties in the United States with high well-being: an observational cross-sectional study |
| title_fullStr | Identifying characteristics of high-poverty counties in the United States with high well-being: an observational cross-sectional study |
| title_full_unstemmed | Identifying characteristics of high-poverty counties in the United States with high well-being: an observational cross-sectional study |
| title_short | Identifying characteristics of high-poverty counties in the United States with high well-being: an observational cross-sectional study |
| title_sort | identifying characteristics of high poverty counties in the united states with high well being an observational cross sectional study |
| url | https://bmjopen.bmj.com/content/10/9/e035645.full |
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