Population and Measure

The selected set of measures are based on chronic disease public health priorities and impact. The measures include the risk behaviors that cause much of the illness, suffering, and early death related to chronic diseases and conditions, as well as the conditions and diseases that are the most common, costly, and preventable of all health problems.

Most measures included in PLACES align with the work of the Chronic Disease Indicators (CDI), which is a partnership between CDC, the National Association of Chronic Disease Directors and the Council of State and Territorial Epidemiologists. Many of our colleagues at state health departments across the country were engaged in the process of arriving at comprehensive measure definitions that include the background, significance, limitations of the indicator, data source, and limitations of the data resources. The definitions for the measures used in the PLACES / 500 Cities project are based on the standard data definitions used in the BRFSS and applied in a multilevel regression and post-stratification approach.

Because we rely on the Behavioral Risk Factor Surveillance System, which only surveys adults aged ≥18 years, we only computed estimates for that population. We could not produce estimates for people aged 17 years or younger.

In December 2023, PLACES included 9 SDOH measures from the American Community Survey 5-year estimates, but they were not updated in the 2024 release. In August 2024, PLACES included 7 model-based estimates of Health-Related Social Needs for 39 states and the District of Columbia based on BRFSS survey 2022 questions. Datasets that provide measures of the social determinants of health are provided in the SDOH Data Linkable to PLACES section. Many of these datasets can be merged with PLACES data or datasets can be overlaid using ArcGIS online services.

Such exposures are not explicitly modeled; however, their effects are statistically captured in the modeling by the inclusion of county- and state-level contextual (fixed and random) effects.

The PLACES project does not include any stratifications by race/ethnicity. However, to the extent that populations within census tracts or ZIP Code Tabulation Areas (ZCTAs) tend to be relatively homogeneous, geographic disparities by census tract or ZCTA may be somewhat reflective of racial/ethnic disparities.