Background: Chronic diseases, such as heart disease, diabetes, and cancer, are the leading causes of disability and death in New York State (NYS) and throughout the United States. County Health Rankings (CHR) is a program assessing the nation’s health on a county-by-county basis to provide a summary z-score for each county and determine county health rankings within the same state annually. The relationship between county health disparity and chronic disease outcomes in NYS has not been evaluated before. Our aim is to examine the association between county health factors as measured by CHR and chronic disease hospitalization and mortality rates (heart disease, diabetes, and cancer) in NYS.

Methods: We obtained county-level heart disease and diabetes hospitalization and mortality rates for 2017-2019 from the New York State Department of Health (NYSDOH). We also obtained NYS all cancer mortality data for 2017-2019 from National Center for Health Statistics provided by the Centers for Disease Control and Prevention (CDC). Overall county health factors z-score was calculated by an equation using weighted measures in 4 different categories: Health Behaviors, Clinical Care, Social and Economic Factors, and Physical Environment. We examined NYS county health factors z-score from 2021 CHR report, which covers data for 2015-2019. The associations between chronic disease outcomes and Overall county health factors z-score and each category z-score were analyzed by negative binomial regression.

Results: From 2017 to 2019, age-adjusted hospitalization rates per 10,000 population for heart disease and diabetes were 84.2 and 18.9, respectively. Age-adjusted mortality rates per 100,000 for heart disease, diabetes, and cancer were 169.4, 17.6, and 137.4, respectively. Among 62 counties, Bronx had the highest z-score (the least healthy county) whereas Nassau had the lowest z-score (the healthiest county) for Overall health factors. In our analysis, counties with higher z-score of Overall health factors were significantly associated with worse outcomes for heart disease (Hospitalization [H], Rate Ratio [RR]: 1.016 [95%CI: 1.006-1.026], per 0.1-unit increase; Mortality [M], 1.016 [1.009-1.023]), diabetes (H, 1.036 [1.022-1.050]; M, 1.035 [1.021-1.049]), and cancer (M, 1.012 [1.007-1.018]). Besides, hospitalization and mortality rates for chronic diseases were significantly greater in counties with higher z-score of Health Behaviors, Clinical Care, and Social and Economic Factors in NYS.

Conclusions: There are significant differences in chronic disease outcomes within NYS. County health disparities as measured by CHR were significantly associated with hospitalization and mortality rates for heart disease, diabetes, and cancer. These findings suggest tailored public health interventions with strategic resource allocation for chronic diseases should be developed in health-disadvantaged areas.

IMAGE 1: Figure 1. Maps of County Health Factors, Heart Disease, Diabetes, and Cancer in New York State

IMAGE 2: Table 1. Association of County Health Rankings with Chronic Disease Outcomes in New York State