Place & Health:
Geography Makes a Difference

Home » Social Determinants of Health in Colorado » Place & Health:
Geography Makes a Difference

Recent research suggests that where people live significantly impacts health outcomes—particularly for low-income people. Wealthy people live longer than lower income people in America, regardless of where they live. But geography matters a great deal for the longevity of people at the lower end of the income spectrum.

In the maps below, it is apparent that not every Coloradan has access, means and opportunity to be the healthiest person they can be. Fairly substantial gaps exist between counties—sometimes neighboring counties—in overall health outcomes.

Health Outcome Rankings by County

Health outcomes vary greatly across the state. People living in some counties in the state are more likely to die prematurely or report poorer health than residents of another county. The healthiest counties experience substantially lower rates of premature death, poor physical health and low birthweight babies than counties at the other end of the health spectrum.

The health outcome measures below are combined into an overall health ranking for each county. In Map 2, we can see how differences in health outcomes play out across the state. Counties ranking in the top third are concentrated along the Front Range and among wealthier mountain resort communities. Counties in the middle third are found along the Eastern Plains and Western Slope. And counties with the worst health outcomes are concentrated in the southern regions of the state—in and around the San Luis Valley.

Table 1. Disparity in health outcomes between best and worst counties in Colorado
Health Outcome Measures, 2016

MeasureBest CO CountiesWorst CO CountiesCO MeanBest US Counties
Premature Death – Years of potential life lost before age 75 per 100,000 population
Poor or Fair Health – Percent of adults reporting poor or fair health
Poor Physical Health Days – Average number of physically unhealthy days reported in the last 30 days2.
Poor Mental Health Days – Average number of mentally unhealthy days reported in the last 30 days
Low Birthweight Births – Percent of live births that are born low birthweight (< 5.5 pounds)6%14%9%6%
Source: Robert Wood Johnson Foundation; all data are age-adjusted

Map 2. Some areas of the state are clearly healthier than others
Health Outcomes Rankings, 2016

Source: Robert Wood Johnson Foundation, County Health Rankings

Premature Death

Premature death—that is, death before age 75—is a common measure of overall population health. Nationally, premature death rates have been slowly declining over the last several decades. We do, however, see differences in the rate of premature death by place. Rural counties consistently have the highest premature death rates.

The map below shows trends in premature death by frontier, rural and urban counties in Colorado. Frontier counties—essentially the most rural areas of the state having 6 or fewer people per square mile— have the highest rate of premature death. In recent years, premature death rates have been declining in frontier counties but increasing in rural counties. Urban counties consistently have the lowest level of premature death.

A complex mix of factors influence differences in health outcomes between rural and urban areas, including differences in health behaviors, access to health care, social and economic factors, and the physical environment.

Map 3. Counties have higher rates of premature death
Years of Potential Lost Life* Under Age 75 per 100k Population, 2016

Source: Robert Wood Johnson Foundation, County Health Rankings

* Premature death is represented by the years of potential life lost before age 75. Every death occurring before the age of 75 contributes to the total number of years of potential life lost. For example, a person who dies at age 25 contributes 50 years of life lost, whereas a person who dies at age 65 contributes 10 years of life lost to a county’s YPLL.

Places Where Lower-Income People Live Longest

The previous maps examined how overall health and longevity varies across the state. This section examines how life expectancy varies by both income and place. Recent research has found geography matters most for the life expectancy of lower income people in America. Nationally, life expectancy for low-income people varies by as much as five years depending on where they live. To put this life expectancy gap in perspective, the Centers for Disease Control estimated that eliminating cancer in the U.S. would increase overall life expectancy by about 3 years.

The maps below show how life expectancy varies for Coloradans in the bottom 25 percent of the income spectrum depending on where they live. (Data was only available for 16 of Colorado’s 64 counties.) What it shows is striking: life expectancy for the lowest income men in Colorado differs by nearly 8 years depending on where they reside in the state. Among women, the difference in life expectancy by geography is nearly 6 years.

Disparities in life expectancy based on geography are not inevitable, however. Lower income people tend to live longest in areas with higher average income (and lower poverty rates), higher levels of education and higher government and community investment. Specifically, investments aimed at health behaviors (smoking, obesity and exercise) and infrastructure benefiting entire communities (mass transit, health services and access to healthy food) positively influence health.

Fig. 11. Disparity in life expectancy by income varies across the state
Life expectancy for men and women in select Colorado counties, by income group, 2014fig11_key

Source: Raj Chetty et al., The Association between Income and Life Expectancy in the United States, 2001 – 2014

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