Social Determinants of Health

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Data Source

All Social Determinants of Health measures use five-year estimates from the American Community Survey (ACS). ACS is a recurring survey of the U.S. population conducted by the U.S. Census Bureau. As with all self-reported sample surveys, ACS data might be subject to error resulting from sampling, nonresponse, or measurement. Margins of errors at a 90 percent confidence interval are provided for each estimate.

Measures
Persons aged ≥ 65 years
Population: Adults aged ≥ 65 years
Numerator: Adults aged ≥ 65 years
Denominator: All people for the same calendar year
Measure: Percentage
Time Period of Case Definition: Calendar year
Summary: In 2022, 17.3% of the U.S. population was aged 65 years or older.1 The number of older adults in the U.S. is expected to continue to increase. By 2060 almost a quarter of the U.S. population will be aged 65 years or older.2 Aging increases the risk of chronic diseases such as dementia, heart disease, type 2 diabetes, arthritis, and cancer which are leading drivers of illness, disability, and death.3 Implementing strategies to promote healthy aging (e.g., promotion of healthy eating and drinking, physical activity, and managing chronic conditions) can help people be as healthy and independent for as long as possible.4
Notes: Measure is from table S0101 (variable S0101_C02_030E). Measure is consistent with the ‘Percentage of persons aged 65 and older estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).
Related Objectives or Recommendations: None
  1. Age and Sex, American Community Survey 1-Year Estimates Subject Tables, Table S0101. United States Census Bureau; 2022. Accessed October 31, 2023. https://data.census.gov/table/ACSST1Y2022.S0101?q=S0101
  2. Vespa J, Medina L, Armstrong DM. Demographic turning points for the United States: Population projections for 2020 to 2060. Current Population Reports, P25-1144, U.S. Census Bureau; 2020. Accessed October 30, 2023. https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf
  3. National Center for Chronic Disease Prevention and Health Promotion. Older Adults and Healthy Aging. Centers for Disease Control and Prevention. Accessed September 22, 2023. https://www.cdc.gov/aging/olderadultsandhealthyaging/index.html
  4. National Center for Chronic Disease Prevention and Health Promotion. 6 tips for healthy aging. Centers for Disease Control and Prevention. Accessed September 22, 2023. https://www.cdc.gov/chronicdisease/resources/infographic/healthy-aging.htm
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No broadband internet subscription among households
Population: All households
Numerator: Households without broadband of any type
Denominator: All households for the same calendar year
Measure: Percentage
Time Period of Case Definition: Current
Summary: In 2022, 8.8 % of households in the United States did not have a broadband internet subscription.1 Residents of rural and tribal areas tend to have lower access to broadband.2-4 Lack of broadband access can limit educational and economic opportunities, as well as delivery of healthcare services remotely through telehealth services.3 Telehealth services have been shown to reduce chronic disease risk factors and improve the management of chronic disease conditions, like cardiovascular disease, diabetes, and obesity.5 Providing grants or loans to internet service providers, healthcare centers, or local governments to expand availability of and lower the costs associated with broadband is one strategy to increase broadband availability.3,4
Notes: Measure is calculated from variables in table S2801. Measure calculation: 100-((S2801_C01_014E/S2801_C01_001E)*100). Measure calculation is consistent with the ‘Broadband access raw value’ provided in the 2022 County Health Rankings.
Related Objectives or Recommendations: Healthy People 2030 objective: HC/HIT 05. Increase the proportion of adults with broadband internet
  1. Types of Computers and Internet Subscriptions, American Community Survey, 1-Year Estimates Subject Tables, Table S2801. United States Census Bureau; 2022. Accessed October 31, 2023. https://data.census.gov/table?q=S2801
  2. 2019 Broadband Deployment Report. Federal Communications Commission, 2019. Accessed June 27, 2023. https://www.fcc.gov/reports-research/reports/broadband-progress-reports/2019-broadband-deployment-report
  3. Bauerly BC, McCord RF, Hulkower R, Pepin D. Broadband access as a public health issue: the role of law in expanding broadband access and connecting underserved communities for better health outcomes. J Law Med Ethics. 2019;47(2_suppl): 39–42. doi.org/10.1177/1073110519857314
  4. Broadband Initiatives for Unserved and Underserved Areas. County Health Rankings and Roadmaps; 2021. Accessed June 27, 2023.  https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/broadband-initiatives-for-unserved-and-underserved-areas
  5. Division for Heart Disease and Stroke Prevention. Telehealth Interventions to Improve Chronic Disease. Centers for Disease Control and Prevention. Updated May 11, 2020. Accessed June 27, 2023. https://www.cdc.gov/dhdsp/pubs/telehealth.htm#table1
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Crowding among housing units
Population: All occupied housing units
Numerator: Occupied housing units with 1.01 to 1.50 and 1.51 or more occupants per room
Denominator: All occupied housing units for the same calendar year
Measure: Percentage
Time Period of Case Definition: Calendar year
Summary: Housing instability encompasses a number of challenges, including moving frequently, spending the bulk of household income on housing costs, and crowding.1,2 In 2022, 3.4% of occupied housing units experienced crowding (defined as units with more than one person per room).1,3 When a rental market becomes unaffordable, people may be forced to move in with others, potentially resulting in crowding.2 Crowding may affect mental health, stress levels, relationships, and sleep, and it may increase the risk of infectious disease.2 Housing subsidies that provide financial assistance to pay rent and public housing assistance programs can help address challenges of housing instability, including crowding.2,4
Notes: Crowding is not a comprehensive measure of housing instability.

Measure is calculated from variables in table DP04. Measure calculation: ((DP04_0078E + DP04_0079E)/DP04_0002E)*100. Measure calculation is consistent with the ‘Percentage of occupied housing units with more people than rooms estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).
Related Objectives or Recommendations: None
  1. Blake KS, Kellerson RL, Simic A. Measuring overcrowding in housing. US Department of Housing and Urban Development, Office of Policy Development and Research; 2007. https://www.huduser.gov/publications/pdf/Measuring_Overcrowding_in_Hsg.pdf.
  2. Healthy People 2030. Housing Instability. U.S Department of Health and Human Services. Accessed June 27, 2023. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/housing-instability
  3. Selected Housing Characteristics, American Community Survey 1-Year Estimates Data Profiles, Table DP04. United States Census Bureau; 2022. Accessed October 31, 2023. https://data.census.gov/table?q=DP04
  4. Aratani Y, Chau MM, Wight V, Addy SD. Rent burden, housing subsidies and the well-being of children and youth. National Center for Children in Poverty, Columbia University. 2011. doi: 10.7916/D8Z89MMD
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Housing cost burden among households
Population: All households
Numerator: Households with annual income less than $75,000 that spend 30% or more of their household income on housing
Denominator: All households for the same calendar year
Measure: Percentage
Time Period of Case Definition: Calendar year
Summary: Housing instability encompasses a number of challenges, including crowding, moving frequently, or spending the bulk of household income on housing costs.1,2 In 2021, 40.6 million households were cost-burdened (spent more than 30% of their income on housing).3 People who are renters, people living in urban areas, and some racial and ethnic minority groups are more likely to experience housing cost burden.4,5 Living in unaffordable housing is associated with overall poor health and increased risk of disease, including hypertension and cardiovascular disease.1,2 Housing subsidies that provide financial assistance to pay rent and public housing assistance programs can help address challenges of housing instability, including housing cost burden.1,5
Notes: Housing cost burden is not a comprehensive measure of housing instability. Measure is calculated from variables in table S2503. Measure calculation: ((S2503_C01_028E + S2503_C01_032E + S2503_C01_036E + S2503_C01_040E)/S2503_C01_001E)*100. Measure calculation is consistent with the ‘Percentage of housing cost-burdened occupied housing units with annual income less than $75,000 (30%+ of income spent on housing costs) estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).
Related Objectives or Recommendations: Healthy People 2030 objective: SDOH-04. Reduce the proportion of families that spend more than 30 percent of income on housing
  1. Healthy People 2030. Housing Instability. U.S Department of Health and Human Services. Accessed June 29, 2023. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/housing-instability
  2. Pollack CE, Griffin BA, Lynch J. Housing affordability and health among homeowners and renters. Am J Prev Med. 2010;39(6):515-21. doi: 10.1016/j.amepre.2010.08.002
  3. Joint Center for Housing Studies. The state of the nation’s housing 2023. Harvard University; 2023. Accessed October 30, 2023. https://www.jchs.harvard.edu/sites/default/files/reports/files/Harvard_JCHS_The_State_of_the_Nations_Housing_2023.pdf
  4. United States Census Bureau. Renters More Likely Than Homeowners to Spend More Than 30% of Income on Housing in Almost All Counties. United States Census Bureau; 2022. Accessed June 29, 2023. https://www.census.gov/library/stories/2022/12/housing-costs-burden.html
  5. Aratani Y, Chau MM, Wight V, Addy SD. Rent burden, housing subsidies and the well-being of children and youth. National Center for Children in Poverty, Columbia University. 2011. doi: 10.7916/D8Z89MMD
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No high school diploma among adults aged ≥ 25 years
Population: Adults aged ≥ 25 years
Numerator: Adults aged ≥ 25 years who did not receive a high school diploma or equivalent
Denominator: Adults aged ≥ 25 years for the same calendar year
Measure: Percentage
Time Period of Case Definition: Calendar year
Summary: In 2022, 10.4% of adults aged 25 years or older had not received a high school diploma or equivalent.1 People from low-income families and some racial and ethnic minority groups are less likely to complete high school.2,3 School resources, such as the number of teachers and size of the school, can also affect a persons’ likelihood of completing high school.3,4 Not completing high school is linked to a variety of factors that can negatively impact health, including limited employment prospects, low wages, and poverty, and people who do not graduate from high school are at a higher risk of developing chronic conditions (e.g., asthma, type 2 diabetes, heart disease, high blood pressure, stroke) and premature mortality.2,3,5,6 Programs that support students transitioning from middle school to high school and allow students to earn college credit while completing high school can help improve graduation rates.3,7
Notes: High school education might be completed after age at assessment.

Measure is from table S0601 (variable S0601_C01_033E). Measure is consistent with the ‘Percentage of persons with no high school diploma (age 25+) estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).
Related Objectives or Recommendations: Healthy People 2030 objective: AH 08. Increase the proportion of high school students who graduate in 4 years
  1. Selected Characteristics of the Total and Native Populations in the United States, American Community Survey 1-Year Estimates Subject Tables, Table S0601. United States Census Bureau; 2022. Accessed October 31, 2023. https://data.census.gov/table?q=S0601
  2. Freudenberg N, Ruglis J. Reframing school dropout as a public health issue. Prev Chronic Dis. 2007; 4(4):A107.
  3. Healthy People 2030. High School Graduation. U.S. Department of Health and Human Services. Accessed April 4, 2023.https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/high-school-graduation
  4. Rumberger RW. Why students drop out of school and what can be done. University of California Los Angeles: The Civil Rights Project; 2001. https://escholarship.org/uc/item/58p2c3wp
  5. Krueger PM, Tran MK, Hummer RA, Chang VW. Mortality attributable to low levels of education in the United States. PLoS One. 2015;10(7):e0131809. doi: 10.1371/journal.pone.0131809
  6. Vaughn MG, Salas-Wright CP, Maynard BR. Dropping out of school and chronic disease in the United States. J Public Health. 2014; 22, 265–270. doi.org/10.1007/s10389-014-0615-x
  7. Wilson SJ, Tanner-Smith EE. Dropout prevention and intervention programs for improving school completion among school-aged children and youth: A systematic review. JSSWR. 2013; 4(4), 357–372. doi: 10.5243/jsswr.2013.22
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Persons living below 150% of the poverty level
Indicator Name: Living below 150% of the poverty level
Population: All people
Numerator: People living below 150% the poverty level
Denominator: All people for the same calendar year
Measure: Percentage
Time Period of Case Definition: Calendar year
Summary: In 2022, approximately 66.2 million people in the US lived below 150% of the poverty level.1 Some racial and ethnic minority groups, people living in rural areas, and people with disabilities have a higher risk of living in poverty.2 Poverty often occurs in concentrated geographic areas and can limit access to educational and employment opportunities, which can perpetuate persistent poverty for families.3 People living in poverty often have reduced access to resources, such as healthcare and healthy foods, which can contribute to a higher risk of developing chronic conditions (e.g., heart disease, stroke, diabetes).2,4 Addressing poverty will require multipronged approaches.2 Programs and policies, including those that provide financial and food assistance and health coverage to families with lower incomes, can help to alleviate some of the negative effects of poverty.2,4
Notes: Measure is calculated from variables in table S1701. Measure calculation: (S1701_C01_040E/S1701_C01_001E)*100. Measure calculation is consistent with the ‘Percentage of persons below 150% poverty estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).
Related Objectives or Recommendations: Healthy People 2030 objective: SDOH01. Reduce the proportion of people living in poverty
  1. Poverty Status in the Past 12 Months, American Community Survey 1-Year Estimates Subject Tables, Table S1701. United States Census Bureau; 2022. Accessed October 31, 2023. https://data.census.gov/table?q=S1701
  2. Healthy People 2030. Poverty. U.S. Department of Health and Human Services. Accessed June 23, 2023. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/poverty
  3. U.S. Department of Agriculture, Economic Research Service. Rural Poverty & Well-Being. U.S. Department of Agriculture; 2022. Updated November 29, 2022. Accessed June 23, 2023. https://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/
  4. Khullar D, Chokshi DA. Health, income, & poverty: where we are & what could help. Health Affairs Health Policy Brief. 2018.  https://doi.org/10.1377/hpb20180817.901935
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Persons of racial or ethnic minority status
Population: All people
Numerator: All people who identify as any of the following: Hispanic or Latino (any race); Black and African American, Non-Hispanic; American Indian and Alaska Native, Non-Hispanic; Asian, Non-Hispanic; Native Hawaiian and Other Pacific Islander, Non-Hispanic; Two or More Races, Non-Hispanic; Other Races, Non-Hispanic
Denominator: All people for the same calendar year
Measure: Percentage
Time Period of Case Definition: Calendar year
Summary: In 2022, 42.3% of the U.S. population identified as a racial or ethnic minority, defined as people who identify as Hispanic or Latino (of any race) or Black and African American, not Hispanic or Latino; or American Indian and Alaska Native, not Hispanic or Latino; or Asian, not Hispanic or Latino; or Native Hawaiian and Other Pacific Islander, not Hispanic or Latino; or other race, not Hispanic or Latino; or two or more races, not Hispanic or Latino.1 Racial discrimination is associated with poor health outcomes such as higher infant mortality rates, higher blood pressure, poorer health status, and worse quality of health care.2 Programs such as CDC’s Racial and Ethnic Approaches to Community Health (REACH) aim to reduce racial and ethnic health disparities and improve health among racial and ethnic minority groups.3
Notes: Measure is calculated from variables in tables DP05 and S0601. Measure calculation: ((DP05_0071E + DP05_0078E + DP05_0079E + DP05_0080E + DP05_0081E + DP05_0082E + DP05_0083E)/ S0601_C01_001E)*100. Measure calculation is consistent with the ‘ Percentage minority estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).
Related Objectives or Recommendations: None
  1. Demographic and Housing Estimates, American Community Survey 1-Year Estimates Data Profiles, Table DP05. United States Census Bureau; 2022. Accessed October 31, 2023. https://data.census.gov/table?q=Dp05
  2. Healthy People 2030. Discrimination. U.S. Department of Health and Human Services. Accessed August 3, 2023. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/discrimination
  3. Division of Nutrition, Physical Activity, and Obesity. Racial and Ethnic Approaches to Community Health. Centers for Disease Control and Prevention. Accessed August 31, 2023. https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/index.htm
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Single-parent households
Indicator Name: Single-parent households
Population: All households
Numerator: All households with a female householder, no spouse/partner present with children of the householder under 18 years and male householder, no spouse/partner present with children of the householder under 18 years
Denominator: All households for the same calendar year
Measure: Percentage
Time Period of Case Definition: Calendar year
Summary: In 2022, there were an estimated 7.7 million single-parent households in the US.1 Adults in single-parent households are more likely to report poor physical and mental health than other parents and have a higher risk of mortality.2,3 Children in single-parent households are more likely to be food insecure, use alcohol, and experience depressive symptoms.4,5 Implementing cross-sector strategies, including education, healthcare, social assistance, and child support programs, can help to address the inequities single-parent families may be more likely to experience.3,6
Notes: Measure is calculated from variables in tables B11012 and DP02. Measure calculation: ((B11012_010E + B11012_015E)/ DP02_0001E)*100. Measure calculation is consistent with the ‘Percentage of single-parent households with children under 18 estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).
Related Objectives or Recommendations: None
  1. Households by type, American Community Survey 1-Year Estimates Detailed Tables, Table B11012. United States Census Bureau; 2022. Accessed October 31, 2023. https://data.census.gov/table?q=B11012
  2. Chiu M, Rahman F, Vigod S, Lau C, Cairney J, Kuryak P. Mortality in single fathers compared with single mothers and partnered parents: a population-based cohort study. Lancet Public Health. 2018;3(3):e115-e123. https://doi.org/10.1016/S2468-2667(18)30003-3
  3. Chiu M, Rahman F, Kurdyak P, Cairney J, Jembere N, Vigod S. Self-rated health and mental health of lone fathers compared with lone mothers and partnered fathers: a population-based cross-sectional study. J Epidemiol Community Health. 2017 May;71(5):417-423. doi: 10.1136/jech-2016-208005.
  4. Balistreri KS. Family Structure and Child Food Insecurity: Evidence from the Current Population Survey. Soc Indic Res. 2018 Aug;138(3):1171-1185. doi: 10.1007/s11205-017-1700-7
  5. Stritzel H, Crosnoe R. Unpacking the linkages between single parent households and early adolescent adjustment. Soc Sci Res. 2023 Feb;110:102841. doi: 10.1016/j.ssresearch.2022.102841.
  6. National Academies of Sciences, Engineering, and Medicine. Vibrant and healthy kids: Aligning science, practice, and policy to advance health equity. The National Academies Press; 2019. https://doi.org/10.17226/25466.
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Unemployment among people ≥ 16 years in the labor force
Population: Population aged ≥ 16 years in the civilian labor force
Numerator: Unemployed population aged ≥ 16 years in the civilian labor force
Denominator: Population aged ≥ 16 years in the civilian labor force
Measure: Percentage
Time Period of Case Definition: Last week or the most recent employment in the past 5 years
Summary: As of September 2023, the unemployment rate nationally was 3.8%.1 The Bureau of Labor Statistics (BLS) defines people who are unemployed as those who are jobless but are available to work and have actively looked for work in the past 4 weeks.2 People with a disability and some racial and ethnic minority groups are more likely to experience unemployment.1,3,4 Unemployment is associated with a higher risk of developing chronic conditions (e.g., stroke, heart attacks, heart disease, and arthritis).5,6 Several strategies have been implemented to mitigate the negative health impacts of unemployment including temporary financial assistance programs and state unemployment benefits.3
Notes: Measure is from table DP03 (variable: DP03_0009PE). Measure is consistent with the ‘Unemployment Rate estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).
Related Objectives or Recommendations: Healthy People 2030 objective: SDOH-02. Increase employment in working-age people.
  1. U.S. Department of Labor, Bureau of Labor Statistics. Employment Situation News Release. U.S. Department of Labor; 2023. Accessed October 30, 2023. https://www.bls.gov/news.release/empsit.nr0.htm
  2. U.S. Department of Labor, Bureau of Labor Statistics. How the Government Measures Unemployment. Accessed September 29, 2023. https://www.bls.gov/cps/cps_htgm.htm#unemployed
  3. Healthy People 2030. Employment. U.S. Department of Health and Human Services. Accessed September 22, 2023. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/employment
  4. National Center on Birth Defects and Developmental Disabilities. Common Barriers to Participation Experienced by People with Disabilities. Centers for Disease Control and Prevention. Accessed June 23, 2023. https://www.cdc.gov/ncbddd/disabilityandhealth/disability-barriers.html
  5. Robert Wood Johnson Foundation. How Does Employment — or Unemployment — Affect Health? Health Policy Snapshot. Robert Wood Johnson Foundation; 2013. https://www.rwjf.org/en/library/research/2012/12/how-does-employment–or-unemployment–affect-health-.html
  6. Avendano M, Berkman LF. Labor markets, employment policies, and health. In: Berkman LF, Kawachi I, Glymour MM, eds. Social Epidemiology. 2nd edition. Oxford Academic; 2014; 182–233. doi: 10.1093/med/9780195377903.003.0006
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