About the Indicators
CHSI 2015 Topic and Indicator Selection Process
CHSI 2015 topic areas (e.g., leading causes of death, poverty), and final set of indicators (e.g., stroke mortality rates, percent of the population whose income fall below the federal poverty level) were selected through a deliberative process in collaboration with partners and subject matter experts. The process for identifying health outcomes and potential determinant topic areas consisted of a CDC staff review of the original Community Health Status Indicators (CHSI) and the more recent CDC monograph, Community Health Assessment for Population Health Improvement: Most Frequently Recommended Health Metrics which identified topic areas that are potentially important for understanding and improving community health. Next, a qualitative review of the scientific literature was performed to better understand the potential relationships between candidate health topic areas and population health outcomes. Finally, a systematic review of similar indicator initiatives and available data sources was conducted. The indicator initiatives reviewed included but were not limited to:
- The County Health Rankings and Roadmaps (www.countyhealthrankings.org)
- United Health Foundation’s America’s Health Rankings (www.americashealthrankings.org))
- State of the USA Health Indicators (www.stateoftheusa.org)
- The Health Indicator’s Warehouse (www.healthindicators.gov)
- Canadian Index of Wellness (www.atkinsonfoundation.ca/ciw)
- Healthy People 2020 (www.healthypeople.gov)
- National Prevention strategy (www.surgeongeneral.gov/initiatives/prevention/strategy/report.pdf)
- Annie E. Casey Foundation’s KIDS COUNT (datacenter.kidscount.org)
The results of these reviews were used to develop an initial candidate set of indicators for the CHSI 2015 launch.
Consistent with previous versions of CHSI, the final set of indicators were required to meet the following criteria:
The indicators were considered important to public health, were actionable, were regularly reported, and were available for at least two-thirds of U.S. counties. Additionally, all health factor indicators included in CHSI 2015 were required to be supported by a body of scientific literature establishing their association with population health outcomes and identifying plausible mechanisms and pathways for those associations. Final indicator selection was based on the synthesized scientific evidence input from external advisors and CDC subject matter experts and consistency with similar indicator initiatives.
Primary and Associated Indicators
For topics where multiple indicators were available such as poverty, we identified a primary indicator based on the following considerations:
- Applicability to the entire or largest percentage of population (e.g., percent of all persons below the poverty level is applicable to a larger portion of the population than percent of children below the poverty level), and
- Indicators are most strongly associated with health (e.g., on-time high school graduation rate vs. percent of adults with an associate college degree).
Important indicators not identified as primary (e.g., percent of older adults in poverty) are included in CHSI 2015 as "associated indicators".
Each CHSI 2015 indicator is accompanied by information describing the significance (importance) of the indicator, source and years of the data, methodology for creating the indicator, and important limitations, where applicable. This information can be found by clicking the "Description" tab for the indicator when viewing county-level results.