Chapter 5.1 · The body keeps the address

Health behaviors and the supply of care

In the most deprived tenth of census tracts, the share of adults who saw a dentist in the past year was 24.4 points lower than in the least deprived tenth, and the share who had a routine checkup was 3.6 points higher.

Author: Vishal Singh
Affiliation: NYU Stern
Published: 9 October 2026

The share of adults who visited a dentist in the past year was 45.8% in the most deprived tenth of census tracts and 70.3% in the least deprived tenth, and the share who had a routine checkup was 77.8% against 74.2%. Both are modeled estimates from the 2024 release of CDC PLACES, which uses survey responses from 2022, and the tenths rank tracts on the Area Deprivation Index (ADI).[1, 2] The chapter places those two measures among the other measures of health that rise with deprivation, the behaviors that sort by income, and the supply of physicians, dentists and mental health providers in deprived counties.

Measures of health and access rise steeply with deprivation, and the annual checkup rises least

The share of adults who smoke was 9.1% (95% CI 8.5% to 9.6%) in the least deprived tenth of tracts and 22.8% (95% CI 22.5% to 23.1%) in the most deprived, 2.5 (95% CI 2.4 to 2.7) times as high. The share with diagnosed diabetes rose from 9.5% to 17.5%. PLACES estimates 83,522 tracts, and 82,781 of them have an ADI rank, so the 741 without one are left out. Tenths hold from 8,118 to 8,511 tracts, because tracts with tied ranks fall in the same tenth. Figure 1 follows 12 measures of health, behavior and access across the whole index. They are this book's selection from the 40 that PLACES publishes for tracts: conditions and behaviors that the first edition followed, insurance, food insecurity and the checkup. For the 11 measures other than the annual checkup, prevalence in the most deprived tenth is between 1.25 (95% CI 1.21 to 1.30) times (depression) and 3.6 (95% CI 3.1 to 4.1) times (all teeth lost among adults ages 65 and over) the prevalence in the least deprived tenth. The curves steepen at the deprived end of the index: for 11 of the 12 measures, the largest step between neighboring twentieths of tracts is the last one.

Figure 1

11 measures are at least 4.8 points more common in the most deprived tenth of tracts than in the least deprived, and the annual checkup is 3.6 points more common

Adults with each condition or behavior, percentage points above the least deprived tenth of tracts, by twentieth of tracts ranked on the Area Deprivation Index national percentile, 2022

Points above the least deprived tenth of tracts

Other measures
Annual checkup

Area Deprivation Index national percentile (1 = least deprived)

Show data

Data for 11 measures are at least 4.8 points more common in the most deprived tenth of tracts than in the least deprived, and the annual checkup is 3.6 points more common
Measure	Mean ADI percentile	Prevalence (%)	Points above least deprived tenth	Lower limit of the 95% interval	Upper limit of the 95% interval	Multiple of least deprived tenth	Tracts
Diagnosed diabetes	3.5	9.1	−0.3	−0.5	−0.1	0.96	4,307
Diagnosed diabetes	8.7	9.9	0.4	0.2	0.6	1.04	3,967
Diagnosed diabetes	13.7	10.2	0.7	0.3	1.1	1.07	4,246
Diagnosed diabetes	18.5	10.5	1.1	0.5	1.6	1.11	3,872
Diagnosed diabetes	23.3	10.3	0.8	0.5	1.2	1.09	4,314
Diagnosed diabetes	28.2	10.6	1.1	0.7	1.7	1.12	4,197
Diagnosed diabetes	33.0	10.7	1.2	0.8	1.7	1.13	4,082
Diagnosed diabetes	37.7	11.0	1.5	1.1	2.0	1.16	4,179
Diagnosed diabetes	42.5	11.3	1.8	1.4	2.3	1.19	3,944
Diagnosed diabetes	47.3	11.6	2.1	1.7	2.6	1.22	4,245
Diagnosed diabetes	52.1	11.9	2.4	2.0	3.0	1.26	4,090
Diagnosed diabetes	56.8	12.3	2.8	2.3	3.3	1.29	4,228
Diagnosed diabetes	61.5	12.6	3.1	2.6	3.7	1.33	4,008
Diagnosed diabetes	66.2	13.0	3.5	3.0	4.1	1.37	4,297
Diagnosed diabetes	71.0	13.4	3.9	3.4	4.5	1.41	4,044
Diagnosed diabetes	75.8	13.8	4.4	3.9	4.9	1.46	4,194
Diagnosed diabetes	80.7	14.4	4.9	4.4	5.5	1.52	4,171
Diagnosed diabetes	85.9	15.2	5.7	5.2	6.3	1.60	4,183
Diagnosed diabetes	91.3	16.4	6.9	6.4	7.5	1.73	4,206
Diagnosed diabetes	97.1	18.9	9.5	8.9	10.1	2.00	4,007
Obesity	3.5	22.5	−1.4	−1.7	−1.1	0.94	4,307
Obesity	8.7	25.4	1.5	1.0	2.0	1.06	3,967
Obesity	13.7	27.4	3.5	2.9	4.2	1.15	4,246
Obesity	18.5	28.8	4.9	4.1	5.6	1.21	3,872
Obesity	23.3	29.8	6.0	5.1	6.7	1.25	4,314
Obesity	28.2	31.1	7.3	6.3	8.1	1.30	4,197
Obesity	33.0	31.7	7.9	7.0	8.7	1.33	4,082
Obesity	37.7	32.6	8.7	7.8	9.5	1.37	4,179
Obesity	42.5	33.5	9.6	8.7	10.4	1.40	3,944
Obesity	47.3	34.2	10.4	9.4	11.1	1.43	4,245
Obesity	52.1	35.0	11.1	10.2	11.9	1.47	4,090
Obesity	56.8	35.8	11.9	11.0	12.7	1.50	4,228
Obesity	61.5	36.4	12.5	11.6	13.3	1.53	4,008
Obesity	66.2	37.3	13.4	12.5	14.2	1.56	4,297
Obesity	71.0	38.0	14.2	13.3	15.0	1.59	4,044
Obesity	75.8	38.7	14.8	13.9	15.6	1.62	4,194
Obesity	80.7	39.6	15.8	14.9	16.6	1.66	4,171
Obesity	85.9	40.6	16.8	15.9	17.5	1.70	4,183
Obesity	91.3	42.3	18.4	17.5	19.2	1.77	4,206
Obesity	97.1	45.8	21.9	20.9	22.8	1.92	4,007
Current smoking	3.5	8.4	−0.6	−0.8	−0.4	0.93	4,307
Current smoking	8.7	9.7	0.7	0.5	0.9	1.07	3,967
Current smoking	13.7	10.5	1.4	0.8	1.8	1.16	4,246
Current smoking	18.5	11.0	2.0	1.4	2.5	1.22	3,872
Current smoking	23.3	11.3	2.2	1.6	2.7	1.25	4,314
Current smoking	28.2	11.9	2.9	2.3	3.5	1.32	4,197
Current smoking	33.0	12.3	3.3	2.7	3.8	1.36	4,082
Current smoking	37.7	13.0	3.9	3.3	4.5	1.43	4,179
Current smoking	42.5	13.5	4.5	3.9	5.0	1.49	3,944
Current smoking	47.3	14.2	5.2	4.6	5.7	1.57	4,245
Current smoking	52.1	14.8	5.7	5.2	6.3	1.63	4,090
Current smoking	56.8	15.4	6.3	5.8	6.9	1.70	4,228
Current smoking	61.5	16.0	6.9	6.4	7.5	1.76	4,008
Current smoking	66.2	16.8	7.7	7.2	8.3	1.85	4,297
Current smoking	71.0	17.4	8.3	7.8	8.9	1.92	4,044
Current smoking	75.8	18.1	9.1	8.5	9.6	2.00	4,194
Current smoking	80.7	19.0	9.9	9.3	10.4	2.09	4,171
Current smoking	85.9	20.0	10.9	10.3	11.5	2.20	4,183
Current smoking	91.3	21.4	12.3	11.7	12.9	2.36	4,206
Current smoking	97.1	24.6	15.5	14.8	16.2	2.71	4,007
Depression	3.5	19.3	−0.2	−0.5	0.0	0.99	4,307
Depression	8.7	19.8	0.3	0.0	0.6	1.01	3,967
Depression	13.7	20.4	0.8	0.4	1.3	1.04	4,246
Depression	18.5	20.7	1.1	0.7	1.6	1.06	3,872
Depression	23.3	21.3	1.8	1.2	2.4	1.09	4,314
Depression	28.2	21.4	1.9	1.2	2.5	1.09	4,197
Depression	33.0	21.7	2.2	1.5	2.9	1.11	4,082
Depression	37.7	22.0	2.4	1.8	3.1	1.12	4,179
Depression	42.5	22.2	2.6	1.9	3.3	1.13	3,944
Depression	47.3	22.5	3.0	2.3	3.7	1.15	4,245
Depression	52.1	22.8	3.2	2.5	4.0	1.17	4,090
Depression	56.8	23.1	3.5	2.8	4.2	1.18	4,228
Depression	61.5	23.2	3.6	2.9	4.4	1.19	4,008
Depression	66.2	23.5	4.0	3.3	4.7	1.20	4,297
Depression	71.0	23.7	4.2	3.5	4.9	1.22	4,044
Depression	75.8	24.0	4.4	3.7	5.2	1.23	4,194
Depression	80.7	24.2	4.7	4.0	5.4	1.24	4,171
Depression	85.9	24.4	4.9	4.2	5.6	1.25	4,183
Depression	91.3	24.4	4.9	4.2	5.6	1.25	4,206
Depression	97.1	24.3	4.8	4.1	5.6	1.25	4,007
Frequent mental distress	3.5	13.4	−0.4	−0.6	−0.2	0.97	4,307
Frequent mental distress	8.7	14.3	0.5	0.3	0.7	1.03	3,967
Frequent mental distress	13.7	15.0	1.1	0.7	1.5	1.08	4,246
Frequent mental distress	18.5	15.3	1.5	1.0	2.0	1.11	3,872
Frequent mental distress	23.3	15.5	1.7	1.3	2.0	1.12	4,314
Frequent mental distress	28.2	15.7	1.9	1.4	2.3	1.13	4,197
Frequent mental distress	33.0	15.9	2.1	1.6	2.5	1.15	4,082
Frequent mental distress	37.7	16.2	2.4	1.9	2.9	1.17	4,179
Frequent mental distress	42.5	16.5	2.6	2.2	3.1	1.19	3,944
Frequent mental distress	47.3	16.7	2.9	2.5	3.4	1.21	4,245
Frequent mental distress	52.1	17.1	3.3	2.9	3.8	1.24	4,090
Frequent mental distress	56.8	17.4	3.5	3.1	4.0	1.25	4,228
Frequent mental distress	61.5	17.7	3.9	3.4	4.3	1.28	4,008
Frequent mental distress	66.2	18.0	4.2	3.8	4.7	1.30	4,297
Frequent mental distress	71.0	18.4	4.5	4.1	5.0	1.33	4,044
Frequent mental distress	75.8	18.7	4.9	4.5	5.4	1.35	4,194
Frequent mental distress	80.7	19.0	5.2	4.8	5.7	1.37	4,171
Frequent mental distress	85.9	19.5	5.7	5.3	6.2	1.41	4,183
Frequent mental distress	91.3	20.3	6.4	6.0	6.9	1.46	4,206
Frequent mental distress	97.1	21.9	8.1	7.6	8.6	1.58	4,007
No leisure-time physical activity	3.5	16.8	−1.0	−1.5	−0.5	0.94	4,307
No leisure-time physical activity	8.7	18.9	1.1	0.5	1.5	1.06	3,967
No leisure-time physical activity	13.7	19.8	2.0	0.6	3.3	1.11	4,246
No leisure-time physical activity	18.5	20.8	3.0	1.3	4.6	1.17	3,872
No leisure-time physical activity	23.3	20.5	2.7	1.2	3.9	1.15	4,314
No leisure-time physical activity	28.2	21.4	3.5	2.0	5.3	1.20	4,197
No leisure-time physical activity	33.0	21.5	3.7	2.3	5.0	1.21	4,082
No leisure-time physical activity	37.7	22.3	4.5	3.1	5.9	1.25	4,179
No leisure-time physical activity	42.5	23.0	5.2	3.8	6.6	1.29	3,944
No leisure-time physical activity	47.3	23.8	6.0	4.5	7.3	1.33	4,245
No leisure-time physical activity	52.1	24.7	6.9	5.5	8.3	1.39	4,090
No leisure-time physical activity	56.8	25.4	7.6	6.2	9.0	1.43	4,228
No leisure-time physical activity	61.5	26.3	8.5	7.1	9.9	1.48	4,008
No leisure-time physical activity	66.2	27.3	9.5	8.1	10.9	1.53	4,297
No leisure-time physical activity	71.0	28.2	10.4	9.0	11.8	1.59	4,044
No leisure-time physical activity	75.8	29.2	11.4	10.1	12.8	1.64	4,194
No leisure-time physical activity	80.7	30.4	12.6	11.2	14.0	1.71	4,171
No leisure-time physical activity	85.9	32.0	14.2	12.8	15.6	1.80	4,183
No leisure-time physical activity	91.3	34.3	16.5	15.1	17.9	1.93	4,206
No leisure-time physical activity	97.1	38.7	20.9	19.5	22.3	2.17	4,007
Short sleep duration	3.5	31.9	−0.8	−1.1	−0.5	0.97	4,307
Short sleep duration	8.7	33.6	0.9	0.5	1.3	1.03	3,967
Short sleep duration	13.7	34.2	1.5	0.5	2.2	1.04	4,246
Short sleep duration	18.5	34.6	1.8	0.7	2.8	1.06	3,872
Short sleep duration	23.3	34.4	1.6	0.5	2.7	1.05	4,314
Short sleep duration	28.2	34.7	2.0	0.8	3.2	1.06	4,197
Short sleep duration	33.0	34.8	2.1	0.9	3.2	1.06	4,082
Short sleep duration	37.7	35.3	2.6	1.4	3.8	1.08	4,179
Short sleep duration	42.5	35.5	2.8	1.6	4.0	1.09	3,944
Short sleep duration	47.3	35.9	3.2	2.0	4.3	1.10	4,245
Short sleep duration	52.1	36.4	3.7	2.5	4.9	1.11	4,090
Short sleep duration	56.8	36.7	4.0	2.8	5.2	1.12	4,228
Short sleep duration	61.5	37.2	4.5	3.2	5.6	1.14	4,008
Short sleep duration	66.2	37.5	4.8	3.6	6.0	1.15	4,297
Short sleep duration	71.0	38.0	5.3	4.1	6.5	1.16	4,044
Short sleep duration	75.8	38.4	5.7	4.5	6.9	1.18	4,194
Short sleep duration	80.7	38.9	6.2	5.0	7.4	1.19	4,171
Short sleep duration	85.9	39.7	7.0	5.8	8.2	1.21	4,183
Short sleep duration	91.3	41.1	8.4	7.2	9.6	1.26	4,206
Short sleep duration	97.1	44.4	11.7	10.5	13.1	1.36	4,007
Food insecurity	3.5	8.3	−1.0	−1.7	−0.3	0.89	3,228
Food insecurity	8.7	10.5	1.2	0.3	1.9	1.13	2,713
Food insecurity	13.7	12.3	2.9	1.1	4.9	1.31	2,931
Food insecurity	18.5	13.4	4.1	1.8	6.6	1.44	2,860
Food insecurity	23.3	12.4	3.0	1.8	4.7	1.32	3,253
Food insecurity	28.2	12.4	3.0	2.1	4.2	1.32	3,173
Food insecurity	33.0	12.8	3.5	2.5	4.9	1.38	3,183
Food insecurity	37.7	13.6	4.3	3.0	6.0	1.46	3,348
Food insecurity	42.5	14.1	4.8	3.6	6.4	1.51	3,125
Food insecurity	47.3	14.6	5.3	3.9	7.0	1.57	3,362
Food insecurity	52.1	15.4	6.1	4.7	7.8	1.65	3,211
Food insecurity	56.8	15.9	6.6	5.1	8.4	1.71	3,394
Food insecurity	61.5	16.9	7.5	6.0	9.3	1.80	3,104
Food insecurity	66.2	17.6	8.2	6.6	10.2	1.88	3,329
Food insecurity	71.0	18.3	9.0	7.5	10.7	1.96	3,194
Food insecurity	75.8	19.4	10.0	8.5	11.8	2.08	3,238
Food insecurity	80.7	20.2	10.8	9.3	12.6	2.16	3,183
Food insecurity	85.9	22.1	12.8	11.3	14.5	2.37	3,193
Food insecurity	91.3	25.7	16.4	14.8	18.3	2.75	3,247
Food insecurity	97.1	33.8	24.4	22.7	26.3	3.62	3,101
No health insurance, ages 18 to 64	3.5	5.6	−0.8	−1.1	−0.4	0.88	4,307
No health insurance, ages 18 to 64	8.7	7.1	0.8	0.4	1.2	1.13	3,967
No health insurance, ages 18 to 64	13.7	8.2	1.9	0.8	3.0	1.29	4,246
No health insurance, ages 18 to 64	18.5	9.3	3.0	1.7	4.6	1.48	3,872
No health insurance, ages 18 to 64	23.3	9.1	2.8	1.8	3.8	1.44	4,314
No health insurance, ages 18 to 64	28.2	9.7	3.4	2.5	4.3	1.54	4,197
No health insurance, ages 18 to 64	33.0	10.0	3.7	2.9	4.5	1.58	4,082
No health insurance, ages 18 to 64	37.7	10.6	4.3	3.4	5.3	1.68	4,179
No health insurance, ages 18 to 64	42.5	11.0	4.7	3.8	5.6	1.74	3,944
No health insurance, ages 18 to 64	47.3	11.2	4.9	4.0	5.8	1.77	4,245
No health insurance, ages 18 to 64	52.1	11.8	5.5	4.5	6.5	1.87	4,090
No health insurance, ages 18 to 64	56.8	12.1	5.8	4.7	6.9	1.92	4,228
No health insurance, ages 18 to 64	61.5	12.8	6.5	5.3	7.7	2.03	4,008
No health insurance, ages 18 to 64	66.2	12.8	6.5	5.3	7.8	2.02	4,297
No health insurance, ages 18 to 64	71.0	13.1	6.8	5.7	8.1	2.08	4,044
No health insurance, ages 18 to 64	75.8	13.6	7.3	6.1	8.7	2.16	4,194
No health insurance, ages 18 to 64	80.7	13.9	7.6	6.5	8.9	2.21	4,171
No health insurance, ages 18 to 64	85.9	14.8	8.4	7.3	9.8	2.34	4,183
No health insurance, ages 18 to 64	91.3	16.5	10.2	8.7	11.9	2.62	4,206
No health insurance, ages 18 to 64	97.1	18.5	12.2	10.8	14.0	2.94	4,007
All teeth lost, ages 65 and over	3.5	6.6	−0.6	−0.9	−0.3	0.92	4,307
All teeth lost, ages 65 and over	8.7	7.8	0.7	0.3	0.9	1.09	3,967
All teeth lost, ages 65 and over	13.7	8.5	1.4	0.2	2.3	1.19	4,246
All teeth lost, ages 65 and over	18.5	9.2	2.0	0.7	3.0	1.28	3,872
All teeth lost, ages 65 and over	23.3	9.3	2.1	0.9	3.1	1.29	4,314
All teeth lost, ages 65 and over	28.2	9.9	2.7	1.4	3.9	1.37	4,197
All teeth lost, ages 65 and over	33.0	10.1	2.9	1.8	3.7	1.40	4,082
All teeth lost, ages 65 and over	37.7	10.6	3.4	2.2	4.3	1.48	4,179
All teeth lost, ages 65 and over	42.5	11.3	4.1	2.9	5.0	1.57	3,944
All teeth lost, ages 65 and over	47.3	11.9	4.7	3.6	5.7	1.66	4,245
All teeth lost, ages 65 and over	52.1	12.7	5.5	4.4	6.5	1.77	4,090
All teeth lost, ages 65 and over	56.8	13.4	6.3	5.1	7.2	1.87	4,228
All teeth lost, ages 65 and over	61.5	14.3	7.1	5.9	8.0	1.98	4,008
All teeth lost, ages 65 and over	66.2	15.3	8.1	6.9	9.1	2.13	4,297
All teeth lost, ages 65 and over	71.0	16.2	9.0	7.8	9.9	2.25	4,044
All teeth lost, ages 65 and over	75.8	17.4	10.2	9.1	11.1	2.42	4,194
All teeth lost, ages 65 and over	80.7	18.5	11.3	10.1	12.2	2.57	4,171
All teeth lost, ages 65 and over	85.9	20.3	13.1	12.0	14.0	2.83	4,183
All teeth lost, ages 65 and over	91.3	23.0	15.8	14.6	16.7	3.20	4,206
All teeth lost, ages 65 and over	97.1	29.5	22.3	21.1	23.4	4.11	4,007
Fair or poor health	3.5	12.7	−0.8	−1.2	−0.3	0.94	4,307
Fair or poor health	8.7	14.3	0.8	0.3	1.2	1.06	3,967
Fair or poor health	13.7	15.2	1.7	0.6	2.9	1.13	4,246
Fair or poor health	18.5	16.1	2.7	1.2	4.3	1.20	3,872
Fair or poor health	23.3	15.7	2.2	1.2	3.2	1.16	4,314
Fair or poor health	28.2	16.2	2.8	1.7	4.1	1.21	4,197
Fair or poor health	33.0	16.2	2.8	1.9	3.8	1.21	4,082
Fair or poor health	37.7	16.9	3.4	2.5	4.5	1.25	4,179
Fair or poor health	42.5	17.4	3.9	3.0	5.0	1.29	3,944
Fair or poor health	47.3	18.0	4.5	3.6	5.6	1.33	4,245
Fair or poor health	52.1	18.7	5.2	4.3	6.3	1.39	4,090
Fair or poor health	56.8	19.3	5.8	4.9	7.0	1.43	4,228
Fair or poor health	61.5	20.2	6.7	5.7	7.8	1.50	4,008
Fair or poor health	66.2	20.9	7.5	6.5	8.6	1.55	4,297
Fair or poor health	71.0	21.7	8.2	7.3	9.3	1.61	4,044
Fair or poor health	75.8	22.7	9.2	8.3	10.4	1.69	4,194
Fair or poor health	80.7	23.7	10.3	9.3	11.4	1.76	4,171
Fair or poor health	85.9	25.3	11.9	10.9	13.0	1.88	4,183
Fair or poor health	91.3	27.8	14.4	13.3	15.6	2.07	4,206
Fair or poor health	97.1	32.9	19.5	18.4	20.6	2.45	4,007
Annual checkup	3.5	74.0	−0.1	−0.6	0.4	1.00	4,307
Annual checkup	8.7	74.3	0.1	−0.4	0.8	1.00	3,967
Annual checkup	13.7	74.3	0.2	−0.7	1.2	1.00	4,246
Annual checkup	18.5	74.2	0.1	−0.9	1.2	1.00	3,872
Annual checkup	23.3	74.5	0.3	−0.6	1.3	1.00	4,314
Annual checkup	28.2	74.8	0.7	−0.4	1.7	1.01	4,197
Annual checkup	33.0	74.8	0.7	−0.4	1.6	1.01	4,082
Annual checkup	37.7	75.0	0.8	−0.3	1.8	1.01	4,179
Annual checkup	42.5	75.3	1.1	0.0	2.1	1.01	3,944
Annual checkup	47.3	75.6	1.5	0.3	2.5	1.02	4,245
Annual checkup	52.1	75.7	1.6	0.4	2.5	1.02	4,090
Annual checkup	56.8	76.0	1.8	0.7	2.8	1.02	4,228
Annual checkup	61.5	76.0	1.9	0.7	2.9	1.02	4,008
Annual checkup	66.2	76.4	2.2	1.1	3.2	1.03	4,297
Annual checkup	71.0	76.6	2.4	1.2	3.4	1.03	4,044
Annual checkup	75.8	76.7	2.5	1.4	3.5	1.03	4,194
Annual checkup	80.7	77.0	2.9	1.7	3.9	1.04	4,171
Annual checkup	85.9	77.2	3.1	1.9	4.1	1.04	4,183
Annual checkup	91.3	77.4	3.3	2.1	4.3	1.04	4,206
Annual checkup	97.1	78.2	4.0	2.8	5.0	1.05	4,007

Every panel ends higher at the right than at the left, and the annual checkup panel, in teal, rises least. Each panel plots the population-weighted mean prevalence in a twentieth of tracts minus the mean in the least deprived tenth, with a 95% interval, against the mean deprivation percentile of those tracts, and the panels share one scale. In 11 of 12 panels the largest step is the last one, into the most deprived twentieth. The second view divides by the least deprived tenth's prevalence instead of subtracting it.Note: PLACES values are modeled estimates. They are built from BRFSS survey responses with census and American Community Survey inputs (county poverty, the age, sex, race and ethnicity of each tract's residents, and education), with state and county random effects, and the Area Deprivation Index is built from American Community Survey data too, so part of each gradient here is mechanical. Within a county, tract values differ through the demographic composition of tracts. The tract file has no intervals; the bands are 95% intervals for the weighted mean from a bootstrap over counties (replicates and seed in the methods note).Note: PLACES 2024 release: BRFSS 2022 for most measures and BRFSS 2021 for blood pressure, blood pressure medicine, high cholesterol and cholesterol screening. Values are crude prevalence among adults, not age-adjusted, so differences in age structure move them.Note: The zero line is the weighted mean of the least deprived tenth of tracts. Tenths hold 8,118 to 8,511 tracts, because tied ranks fall in the same tenth, and twentieths hold fewer, so the first points sit slightly below the line. The food insecurity panel covers fewer tracts, because that question was asked in only some states, so its first points reflect which states fall in each twentieth.Note: The twelve measures are this book's selection from the 40 that PLACES publishes for tracts: conditions and behaviors that the first edition followed, insurance and food insecurity, and the checkup. Tract means weight each tract by all its adults, including for the measures that cover only some ages, such as insurance and tooth loss, because the file carries no population for them.Note: Panel scales are shared, so the prevalence in each twentieth is in the table under Show data.Source: CDC PLACES 2024 release (BRFSS 2022) and Area Deprivation Index 2023; modeled estimates, population-weighted (adults in each tract)

Among the twelve, the annual checkup rises least. Its rate was 74.2% (95% CI 73.2% to 75.3%) in the least deprived tenth and 77.8% (95% CI 77.3% to 78.2%) in the most deprived, a ratio of 1.05 (95% CI 1.03 to 1.06), against 1.25 for depression, the next smallest of the twelve. Of all 40 PLACES measures, 34 are higher in the most deprived tenth, and the checkup has the smallest ratio of them, with 1.08 for blood pressure medicine next. In points the comparison differs: the checkup rises 3.6 (95% CI 2.4 to 4.6) points, and 4 measures outside the twelve (asthma, stroke, high cholesterol and social isolation) rise by less. Depression rises by 4.8 (95% CI 4.1 to 5.6) points, close to the checkup in points but from a much lower base, which is why the second view of the figure, in multiples of the least deprived tenth, separates the two.

Part of every PLACES gradient in this chapter is built in. PLACES does not count anyone. It fits a model to responses from the Behavioral Risk Factor Surveillance System and applies the model to each tract's population, using county poverty, the age, sex, race and ethnicity of the tract's residents and their education, with state and county random effects. The inputs come from the census and the American Community Survey.[1] The Area Deprivation Index is built from American Community Survey data as well,[2] so part of the association between the model's estimates and the index is mechanical. A contrast between two measures, such as the checkup and the dental visit, is not guaranteed by the shared inputs, but the model can produce one through the demographic mix of tracts, because the survey responses it is fitted to differ by age, race and education. Within a county, the model gives tracts different values only through the demographic composition of their residents. Slopes within counties, and in part slopes within states and the coefficient zoo, therefore show how the model maps composition and county inputs into prevalence, and not what the residents of those tracts do. The sections below ask how much of each pattern survives when the state, the county and part of the mix are held fixed.

The PLACES 2024 release uses BRFSS responses from 2022, and from 2021 for blood pressure, blood pressure medicine, high cholesterol and cholesterol screening. Values are crude prevalence among adults, so the age structure of a tract moves them. The tract file carries no intervals, and the bands in this chapter come from resampling counties.

Behaviors and conditions fall with income in every state except binge drinking, which rises

One reading of the gradient is that deprived places are sicker because their residents behave worse. The analysis uses 6 PLACES measures that bear on that reading, and they do not sort the same way. For each state, the prevalence of each across the state's tracts is regressed on the log of tract median household income, with the shares of residents who are older, Black and Hispanic held fixed, and each coefficient is scaled to a doubling of income. A set of such coefficients, 306 here, one per state and measure, is a coefficient zoo (Figure 2), and Chapter 10.1, Gradients, slopes and variance takes up the method.

Smoking, obesity, diabetes, frequent mental distress and physical inactivity all have a negative slope in all 51 states. A doubling of tract income goes with a median of −4.7 points of smoking, −4.3 points of obesity and −6.7 points of physical inactivity, and for each of these measures the interval lies below zero in at least 47 of the 51 states. Binge drinking has the opposite sign. Its slope is positive in 50 states, with a median of +1.2 points per doubling and an interval above zero in 41. Maryland is the one state with a negative estimate, and its interval includes zero.

Figure 2

Binge drinking is higher in higher-income tracts in 50 of 51 states, while the other measures are lower in higher-income tracts in all 51 states

Points of prevalence per doubling of tract median household income, one dot per state and measure, adults, with controls for the age, Black and Hispanic shares of residents, 2022

Interval excludes zero
Interval includes zero

Show data

Data for Binge drinking is higher in higher-income tracts in 50 of 51 states, while the other measures are lower in higher-income tracts in all 51 states
Behavior	State	Points per doubling	Lower limit of the 95% interval	Upper limit of the 95% interval	Tracts
Current smoking	Alabama	−5.29	−6.54	−4.05	1,423
Current smoking	Alaska	−8.13	−10.80	−5.45	173
Current smoking	Arizona	−5.12	−7.05	−3.18	1,725
Current smoking	Arkansas	−6.01	−7.17	−4.85	818
Current smoking	California	−3.66	−4.10	−3.23	9,003
Current smoking	Colorado	−2.88	−3.61	−2.15	1,423
Current smoking	Connecticut	−3.76	−4.87	−2.65	870
Current smoking	Delaware	−3.63	−5.14	−2.13	256
Current smoking	District of Columbia	−2.38	−3.45	−1.32	201
Current smoking	Florida	−4.95	−5.54	−4.36	5,053
Current smoking	Georgia	−5.70	−6.27	−5.14	2,766
Current smoking	Hawaii	−3.96	−4.52	−3.40	419
Current smoking	Idaho	−3.30	−4.00	−2.59	453
Current smoking	Illinois	−4.67	−5.93	−3.42	3,239
Current smoking	Indiana	−5.07	−6.55	−3.60	1,678
Current smoking	Iowa	−4.47	−5.64	−3.31	890
Current smoking	Kansas	−5.16	−6.46	−3.87	811
Current smoking	Kentucky	−7.14	−7.89	−6.38	1,287
Current smoking	Louisiana	−6.01	−6.60	−5.43	1,352
Current smoking	Maine	−5.80	−6.68	−4.91	399
Current smoking	Maryland	−4.84	−5.75	−3.92	1,449
Current smoking	Massachusetts	−3.95	−5.70	−2.20	1,585
Current smoking	Michigan	−5.85	−6.69	−5.01	2,869
Current smoking	Minnesota	−4.56	−5.34	−3.78	1,497
Current smoking	Mississippi	−5.77	−7.25	−4.29	865
Current smoking	Missouri	−6.34	−7.36	−5.31	1,644
Current smoking	Montana	−6.65	−8.29	−5.00	315
Current smoking	Nebraska	−3.80	−4.23	−3.37	550
Current smoking	Nevada	−4.54	−5.64	−3.44	767
Current smoking	New Hampshire	−4.38	−5.14	−3.62	347
Current smoking	New Jersey	−4.31	−4.87	−3.75	2,154
Current smoking	New Mexico	−6.93	−8.55	−5.31	594
Current smoking	New York	−4.70	−5.23	−4.17	5,182
Current smoking	North Carolina	−5.40	−6.02	−4.78	2,628
Current smoking	North Dakota	−4.04	−6.23	−1.86	227
Current smoking	Ohio	−6.77	−7.24	−6.30	3,129
Current smoking	Oklahoma	−6.30	−7.23	−5.36	1,189
Current smoking	Oregon	−4.57	−5.48	−3.66	991
Current smoking	Pennsylvania	−5.51	−5.98	−5.05	3,377
Current smoking	Rhode Island	−4.53	−5.11	−3.94	246
Current smoking	South Carolina	−5.61	−6.44	−4.78	1,301
Current smoking	South Dakota	−7.73	−10.72	−4.74	242
Current smoking	Tennessee	−6.64	−7.92	−5.36	1,675
Current smoking	Texas	−4.35	−4.98	−3.73	6,802
Current smoking	Utah	−1.76	−2.66	−0.86	707
Current smoking	Vermont	−3.95	−5.08	−2.83	192
Current smoking	Virginia	−4.66	−5.25	−4.07	2,152
Current smoking	Washington	−3.93	−4.54	−3.32	1,767
Current smoking	West Virginia	−5.86	−7.73	−3.99	543
Current smoking	Wisconsin	−4.04	−4.66	−3.42	1,523
Current smoking	Wyoming	−2.44	−5.45	0.56	159
Obesity	Alabama	−4.19	−5.38	−3.00	1,423
Obesity	Alaska	−5.44	−6.79	−4.08	173
Obesity	Arizona	−2.94	−4.29	−1.60	1,725
Obesity	Arkansas	−4.27	−5.48	−3.06	818
Obesity	California	−4.02	−5.36	−2.69	9,003
Obesity	Colorado	−1.90	−3.21	−0.58	1,423
Obesity	Connecticut	−5.18	−7.75	−2.61	870
Obesity	Delaware	−3.57	−4.88	−2.26	256
Obesity	District of Columbia	−1.46	−2.58	−0.33	201
Obesity	Florida	−5.09	−5.94	−4.24	5,053
Obesity	Georgia	−6.05	−7.26	−4.83	2,766
Obesity	Hawaii	−3.12	−3.40	−2.84	419
Obesity	Idaho	−3.29	−4.95	−1.62	453
Obesity	Illinois	−4.31	−5.85	−2.77	3,239
Obesity	Indiana	−3.79	−5.61	−1.96	1,678
Obesity	Iowa	−3.37	−4.61	−2.12	890
Obesity	Kansas	−4.54	−5.89	−3.19	811
Obesity	Kentucky	−5.33	−6.31	−4.34	1,287
Obesity	Louisiana	−5.19	−6.09	−4.30	1,352
Obesity	Maine	−6.92	−8.25	−5.60	399
Obesity	Maryland	−5.11	−7.78	−2.45	1,449
Obesity	Massachusetts	−3.57	−5.94	−1.20	1,585
Obesity	Michigan	−5.40	−6.53	−4.27	2,869
Obesity	Minnesota	−5.36	−6.53	−4.18	1,497
Obesity	Mississippi	−4.27	−5.67	−2.86	865
Obesity	Missouri	−4.95	−6.98	−2.93	1,644
Obesity	Montana	−5.67	−8.49	−2.85	315
Obesity	Nebraska	−3.15	−4.74	−1.56	550
Obesity	Nevada	−3.67	−4.87	−2.48	767
Obesity	New Hampshire	−2.80	−4.04	−1.56	347
Obesity	New Jersey	−5.19	−6.17	−4.22	2,154
Obesity	New Mexico	−5.71	−6.82	−4.61	594
Obesity	New York	−5.19	−6.80	−3.59	5,182
Obesity	North Carolina	−4.68	−5.96	−3.40	2,628
Obesity	North Dakota	−2.65	−4.32	−0.98	227
Obesity	Ohio	−5.73	−6.28	−5.18	3,129
Obesity	Oklahoma	−4.94	−6.09	−3.79	1,189
Obesity	Oregon	−3.21	−4.36	−2.07	991
Obesity	Pennsylvania	−4.76	−5.47	−4.05	3,377
Obesity	Rhode Island	−3.64	−5.39	−1.90	246
Obesity	South Carolina	−5.64	−6.83	−4.46	1,301
Obesity	South Dakota	−4.30	−5.52	−3.08	242
Obesity	Tennessee	−5.61	−7.06	−4.16	1,675
Obesity	Texas	−3.87	−4.48	−3.25	6,802
Obesity	Utah	−1.56	−2.61	−0.51	707
Obesity	Vermont	−3.52	−4.60	−2.43	192
Obesity	Virginia	−4.49	−5.82	−3.17	2,152
Obesity	Washington	−5.22	−7.57	−2.88	1,767
Obesity	West Virginia	−3.40	−4.67	−2.14	543
Obesity	Wisconsin	−3.44	−4.32	−2.57	1,523
Obesity	Wyoming	−3.13	−7.58	1.33	159
Diagnosed diabetes	Alabama	−2.33	−3.32	−1.34	1,423
Diagnosed diabetes	Alaska	−2.87	−3.89	−1.84	173
Diagnosed diabetes	Arizona	−2.22	−3.76	−0.69	1,725
Diagnosed diabetes	Arkansas	−2.85	−3.87	−1.84	818
Diagnosed diabetes	California	−1.35	−1.71	−0.98	9,003
Diagnosed diabetes	Colorado	−0.76	−1.28	−0.25	1,423
Diagnosed diabetes	Connecticut	−1.76	−2.78	−0.74	870
Diagnosed diabetes	Delaware	−0.86	−2.34	0.62	256
Diagnosed diabetes	District of Columbia	−0.39	−0.92	0.13	201
Diagnosed diabetes	Florida	−2.46	−3.01	−1.90	5,053
Diagnosed diabetes	Georgia	−2.57	−3.04	−2.09	2,766
Diagnosed diabetes	Hawaii	−1.82	−2.94	−0.70	419
Diagnosed diabetes	Idaho	−1.23	−2.01	−0.46	453
Diagnosed diabetes	Illinois	−1.71	−2.59	−0.83	3,239
Diagnosed diabetes	Indiana	−1.57	−2.43	−0.72	1,678
Diagnosed diabetes	Iowa	−1.28	−2.25	−0.31	890
Diagnosed diabetes	Kansas	−1.75	−2.43	−1.07	811
Diagnosed diabetes	Kentucky	−3.07	−3.50	−2.63	1,287
Diagnosed diabetes	Louisiana	−3.08	−3.65	−2.51	1,352
Diagnosed diabetes	Maine	−2.38	−2.91	−1.86	399
Diagnosed diabetes	Maryland	−1.72	−2.41	−1.03	1,449
Diagnosed diabetes	Massachusetts	−1.43	−2.19	−0.66	1,585
Diagnosed diabetes	Michigan	−2.11	−2.63	−1.60	2,869
Diagnosed diabetes	Minnesota	−1.59	−1.96	−1.22	1,497
Diagnosed diabetes	Mississippi	−3.08	−4.13	−2.04	865
Diagnosed diabetes	Missouri	−2.30	−2.85	−1.76	1,644
Diagnosed diabetes	Montana	−2.87	−3.85	−1.90	315
Diagnosed diabetes	Nebraska	−0.99	−1.47	−0.52	550
Diagnosed diabetes	Nevada	−2.04	−2.93	−1.14	767
Diagnosed diabetes	New Hampshire	−1.35	−1.94	−0.75	347
Diagnosed diabetes	New Jersey	−1.46	−1.94	−0.99	2,154
Diagnosed diabetes	New Mexico	−3.61	−4.53	−2.69	594
Diagnosed diabetes	New York	−2.24	−2.87	−1.61	5,182
Diagnosed diabetes	North Carolina	−2.41	−2.95	−1.87	2,628
Diagnosed diabetes	North Dakota	−1.70	−3.17	−0.23	227
Diagnosed diabetes	Ohio	−2.58	−2.99	−2.18	3,129
Diagnosed diabetes	Oklahoma	−2.95	−3.68	−2.23	1,189
Diagnosed diabetes	Oregon	−1.38	−2.13	−0.62	991
Diagnosed diabetes	Pennsylvania	−1.91	−2.22	−1.59	3,377
Diagnosed diabetes	Rhode Island	−2.01	−2.55	−1.47	246
Diagnosed diabetes	South Carolina	−2.82	−3.47	−2.18	1,301
Diagnosed diabetes	South Dakota	−3.14	−4.61	−1.67	242
Diagnosed diabetes	Tennessee	−2.84	−3.76	−1.91	1,675
Diagnosed diabetes	Texas	−1.86	−2.42	−1.29	6,802
Diagnosed diabetes	Utah	−0.38	−1.20	0.45	707
Diagnosed diabetes	Vermont	−1.09	−1.61	−0.57	192
Diagnosed diabetes	Virginia	−1.49	−1.94	−1.05	2,152
Diagnosed diabetes	Washington	−1.41	−1.93	−0.89	1,767
Diagnosed diabetes	West Virginia	−2.40	−3.84	−0.95	543
Diagnosed diabetes	Wisconsin	−1.03	−1.50	−0.55	1,523
Diagnosed diabetes	Wyoming	−1.02	−2.99	0.94	159
Frequent mental distress	Alabama	−4.47	−4.82	−4.12	1,423
Frequent mental distress	Alaska	−4.04	−5.03	−3.04	173
Frequent mental distress	Arizona	−4.21	−5.30	−3.11	1,725
Frequent mental distress	Arkansas	−4.24	−4.78	−3.70	818
Frequent mental distress	California	−3.34	−3.76	−2.93	9,003
Frequent mental distress	Colorado	−3.44	−4.15	−2.73	1,423
Frequent mental distress	Connecticut	−3.41	−3.88	−2.93	870
Frequent mental distress	Delaware	−3.95	−5.59	−2.31	256
Frequent mental distress	District of Columbia	−3.02	−4.58	−1.45	201
Frequent mental distress	Florida	−3.51	−3.82	−3.20	5,053
Frequent mental distress	Georgia	−4.03	−4.25	−3.80	2,766
Frequent mental distress	Hawaii	−2.41	−2.82	−2.00	419
Frequent mental distress	Idaho	−4.19	−5.20	−3.17	453
Frequent mental distress	Illinois	−3.42	−3.79	−3.05	3,239
Frequent mental distress	Indiana	−4.33	−4.68	−3.98	1,678
Frequent mental distress	Iowa	−4.31	−5.00	−3.62	890
Frequent mental distress	Kansas	−3.96	−4.35	−3.57	811
Frequent mental distress	Kentucky	−4.11	−4.41	−3.80	1,287
Frequent mental distress	Louisiana	−3.71	−4.17	−3.25	1,352
Frequent mental distress	Maine	−3.60	−4.13	−3.07	399
Frequent mental distress	Maryland	−3.93	−4.17	−3.69	1,449
Frequent mental distress	Massachusetts	−3.54	−3.83	−3.26	1,585
Frequent mental distress	Michigan	−4.30	−4.59	−4.00	2,869
Frequent mental distress	Minnesota	−3.95	−4.32	−3.58	1,497
Frequent mental distress	Mississippi	−3.82	−4.30	−3.34	865
Frequent mental distress	Missouri	−4.22	−4.65	−3.79	1,644
Frequent mental distress	Montana	−4.06	−4.83	−3.29	315
Frequent mental distress	Nebraska	−3.52	−3.99	−3.06	550
Frequent mental distress	Nevada	−2.82	−3.21	−2.42	767
Frequent mental distress	New Hampshire	−3.46	−4.09	−2.83	347
Frequent mental distress	New Jersey	−3.18	−3.63	−2.73	2,154
Frequent mental distress	New Mexico	−4.02	−4.70	−3.34	594
Frequent mental distress	New York	−2.93	−3.35	−2.50	5,182
Frequent mental distress	North Carolina	−3.89	−4.14	−3.64	2,628
Frequent mental distress	North Dakota	−3.91	−4.69	−3.13	227
Frequent mental distress	Ohio	−4.71	−4.99	−4.43	3,129
Frequent mental distress	Oklahoma	−4.33	−4.60	−4.06	1,189
Frequent mental distress	Oregon	−4.19	−4.87	−3.50	991
Frequent mental distress	Pennsylvania	−3.60	−3.82	−3.38	3,377
Frequent mental distress	Rhode Island	−2.93	−3.65	−2.22	246
Frequent mental distress	South Carolina	−3.80	−4.32	−3.28	1,301
Frequent mental distress	South Dakota	−4.69	−5.57	−3.81	242
Frequent mental distress	Tennessee	−4.32	−4.50	−4.14	1,675
Frequent mental distress	Texas	−3.83	−4.11	−3.55	6,802
Frequent mental distress	Utah	−3.80	−5.22	−2.38	707
Frequent mental distress	Vermont	−4.37	−5.55	−3.19	192
Frequent mental distress	Virginia	−3.86	−4.08	−3.63	2,152
Frequent mental distress	Washington	−4.30	−4.64	−3.96	1,767
Frequent mental distress	West Virginia	−4.42	−5.08	−3.77	543
Frequent mental distress	Wisconsin	−4.26	−4.76	−3.76	1,523
Frequent mental distress	Wyoming	−3.49	−4.43	−2.55	159
No leisure-time physical activity	Alabama	−8.26	−9.49	−7.02	1,423
No leisure-time physical activity	Alaska	−7.43	−9.28	−5.57	173
No leisure-time physical activity	Arizona	−6.01	−7.81	−4.22	1,725
No leisure-time physical activity	Arkansas	−9.36	−10.76	−7.97	818
No leisure-time physical activity	California	−5.16	−5.83	−4.48	9,003
No leisure-time physical activity	Colorado	−3.81	−4.54	−3.07	1,423
No leisure-time physical activity	Connecticut	−5.60	−6.98	−4.22	870
No leisure-time physical activity	Delaware	−6.14	−7.34	−4.95	256
No leisure-time physical activity	District of Columbia	−3.05	−3.82	−2.27	201
No leisure-time physical activity	Florida	−7.40	−8.10	−6.70	5,053
No leisure-time physical activity	Georgia	−8.61	−9.48	−7.73	2,766
No leisure-time physical activity	Hawaii	−4.83	−7.09	−2.57	419
No leisure-time physical activity	Idaho	−6.49	−7.48	−5.50	453
No leisure-time physical activity	Illinois	−6.54	−7.55	−5.53	3,239
No leisure-time physical activity	Indiana	−7.30	−8.70	−5.91	1,678
No leisure-time physical activity	Iowa	−7.56	−8.65	−6.46	890
No leisure-time physical activity	Kansas	−6.53	−7.42	−5.63	811
No leisure-time physical activity	Kentucky	−9.02	−9.63	−8.41	1,287
No leisure-time physical activity	Louisiana	−8.32	−9.14	−7.50	1,352
No leisure-time physical activity	Maine	−8.03	−9.35	−6.70	399
No leisure-time physical activity	Maryland	−6.69	−7.77	−5.62	1,449
No leisure-time physical activity	Massachusetts	−5.93	−7.56	−4.29	1,585
No leisure-time physical activity	Michigan	−7.22	−8.06	−6.37	2,869
No leisure-time physical activity	Minnesota	−6.25	−6.85	−5.65	1,497
No leisure-time physical activity	Mississippi	−8.38	−10.04	−6.72	865
No leisure-time physical activity	Missouri	−8.13	−8.97	−7.29	1,644
No leisure-time physical activity	Montana	−8.17	−9.75	−6.58	315
No leisure-time physical activity	Nebraska	−5.56	−6.21	−4.91	550
No leisure-time physical activity	Nevada	−5.65	−7.08	−4.22	767
No leisure-time physical activity	New Hampshire	−5.29	−6.12	−4.46	347
No leisure-time physical activity	New Jersey	−5.76	−6.59	−4.92	2,154
No leisure-time physical activity	New Mexico	−7.85	−9.10	−6.59	594
No leisure-time physical activity	New York	−6.95	−8.08	−5.82	5,182
No leisure-time physical activity	North Carolina	−7.53	−8.25	−6.82	2,628
No leisure-time physical activity	North Dakota	−6.37	−8.10	−4.63	227
No leisure-time physical activity	Ohio	−8.44	−8.88	−8.00	3,129
No leisure-time physical activity	Oklahoma	−9.23	−10.46	−7.99	1,189
No leisure-time physical activity	Oregon	−5.06	−5.98	−4.14	991
No leisure-time physical activity	Pennsylvania	−6.93	−7.46	−6.40	3,377
No leisure-time physical activity	Rhode Island	−5.88	−6.26	−5.50	246
No leisure-time physical activity	South Carolina	−8.46	−9.27	−7.64	1,301
No leisure-time physical activity	South Dakota	−7.28	−9.25	−5.30	242
No leisure-time physical activity	Tennessee	−8.52	−9.83	−7.21	1,675
No leisure-time physical activity	Texas	−6.93	−7.78	−6.07	6,802
No leisure-time physical activity	Utah	−3.44	−4.31	−2.56	707
No leisure-time physical activity	Vermont	−5.43	−6.39	−4.47	192
No leisure-time physical activity	Virginia	−5.79	−6.42	−5.16	2,152
No leisure-time physical activity	Washington	−5.31	−6.22	−4.40	1,767
No leisure-time physical activity	West Virginia	−8.03	−9.68	−6.37	543
No leisure-time physical activity	Wisconsin	−6.16	−6.64	−5.68	1,523
No leisure-time physical activity	Wyoming	−4.84	−8.10	−1.57	159
Binge drinking	Alabama	1.26	0.97	1.54	1,423
Binge drinking	Alaska	1.02	0.43	1.61	173
Binge drinking	Arizona	0.91	0.37	1.44	1,725
Binge drinking	Arkansas	1.97	1.23	2.71	818
Binge drinking	California	0.66	−0.07	1.40	9,003
Binge drinking	Colorado	0.65	−0.18	1.47	1,423
Binge drinking	Connecticut	0.15	−0.40	0.70	870
Binge drinking	Delaware	0.95	0.63	1.28	256
Binge drinking	District of Columbia	0.92	0.13	1.70	201
Binge drinking	Florida	1.18	0.86	1.49	5,053
Binge drinking	Georgia	1.35	0.96	1.75	2,766
Binge drinking	Hawaii	0.97	0.41	1.53	419
Binge drinking	Idaho	1.16	0.71	1.61	453
Binge drinking	Illinois	1.54	0.70	2.38	3,239
Binge drinking	Indiana	1.20	0.61	1.79	1,678
Binge drinking	Iowa	1.49	1.23	1.76	890
Binge drinking	Kansas	0.65	0.22	1.07	811
Binge drinking	Kentucky	1.99	1.73	2.24	1,287
Binge drinking	Louisiana	2.33	1.81	2.84	1,352
Binge drinking	Maine	1.74	0.89	2.59	399
Binge drinking	Maryland	−0.77	−1.71	0.17	1,449
Binge drinking	Massachusetts	0.51	−0.26	1.27	1,585
Binge drinking	Michigan	1.12	0.41	1.84	2,869
Binge drinking	Minnesota	0.63	−0.05	1.32	1,497
Binge drinking	Mississippi	1.41	0.90	1.92	865
Binge drinking	Missouri	1.88	1.42	2.34	1,644
Binge drinking	Montana	2.18	1.44	2.93	315
Binge drinking	Nebraska	0.91	0.58	1.23	550
Binge drinking	Nevada	0.89	0.19	1.59	767
Binge drinking	New Hampshire	1.12	0.05	2.20	347
Binge drinking	New Jersey	0.36	−0.19	0.90	2,154
Binge drinking	New Mexico	1.59	1.17	2.02	594
Binge drinking	New York	1.37	0.26	2.48	5,182
Binge drinking	North Carolina	1.57	0.96	2.18	2,628
Binge drinking	North Dakota	1.94	1.42	2.46	227
Binge drinking	Ohio	1.67	1.25	2.09	3,129
Binge drinking	Oklahoma	1.68	0.95	2.41	1,189
Binge drinking	Oregon	1.01	0.59	1.43	991
Binge drinking	Pennsylvania	1.16	0.68	1.63	3,377
Binge drinking	Rhode Island	1.13	0.64	1.62	246
Binge drinking	South Carolina	2.25	1.24	3.26	1,301
Binge drinking	South Dakota	1.32	0.46	2.18	242
Binge drinking	Tennessee	1.99	1.39	2.60	1,675
Binge drinking	Texas	0.89	0.49	1.28	6,802
Binge drinking	Utah	1.44	0.99	1.89	707
Binge drinking	Vermont	1.21	0.28	2.15	192
Binge drinking	Virginia	0.04	−0.72	0.79	2,152
Binge drinking	Washington	0.37	−0.17	0.92	1,767
Binge drinking	West Virginia	1.62	1.11	2.14	543
Binge drinking	Wisconsin	1.43	0.91	1.95	1,523
Binge drinking	Wyoming	0.82	−0.66	2.30	159

The strips for the other measures lie left of zero in every state and the binge drinking strip lies right of zero in all but one. Each dot is one state's coefficient from a population-weighted regression across its tracts, and the key marks the dots whose 95% interval excludes zero.Note: Each dot is a regression across the tracts of one state, and every state has at least 60 tracts with all the variables. The intervals use counties as clusters; Delaware and the District of Columbia use HC3 errors because they have too few counties for cluster-robust errors. The strip medians are printed on the chart.Note: PLACES values are modeled estimates. They are built from BRFSS survey responses with census and American Community Survey inputs (county poverty, the age, sex, race and ethnicity of each tract's residents, and education), with state and county random effects, and the Area Deprivation Index is built from American Community Survey data too, so part of each gradient here is mechanical. Within a county, tract values differ through the demographic composition of tracts. Income comes from the same survey, and the controls remove only the age, Black and Hispanic shares. Race-alone shares include Hispanic residents, and median household income is top-coded in the survey.Note: These are differences between tracts within a state. They do not describe what any person does.Source: CDC PLACES 2024 release (BRFSS 2022) and ACS 2019-2023; modeled estimates, population-weighted (adults in each tract)

These are differences between tracts, and they do not say who drinks. Tracts with higher incomes have a higher modeled share of adults who binge drink, and tract values cannot show whether the drinkers are the high-income residents of those tracts. Survey estimates for individuals, with design-based intervals, are the subject of Chapter 5.2, Health behaviors, person by person. The PLACES model and the census income measure share inputs, so the coefficients show what those inputs and the survey responses give together. Whatever the model contributes, the six measures do not share one direction with income, and an index of deprivation does not rank places on all of them alike.

The annual checkup does not follow the gradient that the dental visit does

The checkup measures contact with a physician, and the dental visit measures routine dental care, which is mostly preventive. Figure 3 plots both against the index. The dental visit rate falls from 70.3% (95% CI 68.5% to 72.1%) in the least deprived tenth of tracts to 45.8% (95% CI 45.0% to 46.6%) in the most deprived, 24.4 (95% CI 22.5 to 26.5) points lower. The checkup rate rises from 74.2% to 77.8%, 3.6 (95% CI 2.4 to 4.6) points higher. Across the most deprived tenth of the index the dental line falls fastest and the checkup line rises fastest.

Figure 3

From the least to the most deprived tenth of tracts, the dental visit rate falls from 70.3% to 45.8% while the annual checkup rate rises from 74.2% to 77.8%

Adults who visited a dentist or had a routine checkup in the past year, percent, by Area Deprivation Index national percentile of the tract, 2022

Show data

Data for From the least to the most deprived tenth of tracts, the dental visit rate falls from 70.3% to 45.8% while the annual checkup rate rises from 74.2% to 77.8%
conf_high	conf_low	estimate	measure	n_units	percentile
76.10	73	74.40	Annual checkup	693	1
75.42	71.84	73.47	Annual checkup	779	2
75.32	72.22	73.62	Annual checkup	587	3
75.30	72.99	74.01	Annual checkup	925	4
75.49	73.33	74.33	Annual checkup	636	5
75.67	73.40	74.46	Annual checkup	979	6
75.45	73.35	74.30	Annual checkup	607	7
75.31	73.27	74.18	Annual checkup	915	8
75.30	73.30	74.22	Annual checkup	677	9
75.64	73.39	74.42	Annual checkup	1,000	10
75.45	73.49	74.38	Annual checkup	598	11
75.94	73.39	74.58	Annual checkup	1,019	12
75.39	72.90	74.03	Annual checkup	693	13
75.74	73.59	74.63	Annual checkup	1,007	14
75.36	72.98	74.08	Annual checkup	656	15
75.32	73.07	74.13	Annual checkup	1,054	16
75.65	72.97	74.29	Annual checkup	684	17
75.20	73.14	74.12	Annual checkup	1,033	18
74.96	72.70	73.80	Annual checkup	702	19
75.70	73.47	74.58	Annual checkup	1,019	20
75.18	73.25	74.18	Annual checkup	655	21
75.39	73.71	74.55	Annual checkup	1,098	22
75.52	73.77	74.64	Annual checkup	652	23
75.17	73.45	74.31	Annual checkup	1,050	24
75.28	73.86	74.56	Annual checkup	679	25
75.39	74.06	74.72	Annual checkup	1,028	26
75.60	73.91	74.77	Annual checkup	678	27
75.54	74.17	74.86	Annual checkup	1,029	28
75.67	74.13	74.90	Annual checkup	659	29
75.64	74.31	74.98	Annual checkup	1,112	30
75.35	73.93	74.62	Annual checkup	668	31
75.39	74.19	74.79	Annual checkup	1,010	32
75.39	74.01	74.70	Annual checkup	689	33
75.41	74.28	74.84	Annual checkup	1,053	34
75.74	74.51	75.13	Annual checkup	672	35
75.51	74.30	74.88	Annual checkup	1,098	36
75.33	74.10	74.71	Annual checkup	730	37
75.58	74.42	75.01	Annual checkup	1,031	38
76.08	74.90	75.48	Annual checkup	620	39
75.63	74.54	75.08	Annual checkup	995	40
75.69	74.46	75.08	Annual checkup	709	41
75.70	74.73	75.22	Annual checkup	1,045	42
75.85	74.69	75.25	Annual checkup	690	43
75.92	74.82	75.38	Annual checkup	1,044	44
76.03	75.03	75.53	Annual checkup	689	45
76.22	75.30	75.74	Annual checkup	1,008	46
76.33	75.20	75.74	Annual checkup	655	47
75.99	75	75.50	Annual checkup	1,070	48
76.34	75.26	75.80	Annual checkup	652	49
75.98	75.02	75.48	Annual checkup	1,066	50
76.16	75.04	75.58	Annual checkup	667	51
76.44	75.51	75.98	Annual checkup	1,106	52
76.19	75.32	75.75	Annual checkup	721	53
76.28	75.26	75.75	Annual checkup	1,047	54
76.55	75.55	76.04	Annual checkup	670	55
76.34	75.42	75.87	Annual checkup	1,069	56
76.32	75.32	75.82	Annual checkup	664	57
76.63	75.65	76.15	Annual checkup	1,046	58
76.44	75.45	75.94	Annual checkup	756	59
76.47	75.54	75.98	Annual checkup	1,056	60
76.50	75.52	76	Annual checkup	672	61
76.44	75.45	75.96	Annual checkup	1,107	62
76.55	75.51	76.01	Annual checkup	679	63
76.69	75.70	76.21	Annual checkup	1,061	64
76.72	75.49	76.14	Annual checkup	699	65
76.91	76.02	76.48	Annual checkup	1,041	66
76.96	76	76.49	Annual checkup	696	67
77	76.17	76.60	Annual checkup	1,028	68
76.97	76.14	76.55	Annual checkup	679	69
76.83	76.08	76.46	Annual checkup	1,030	70
77.05	76.15	76.62	Annual checkup	711	71
77.10	76.28	76.70	Annual checkup	1,040	72
76.94	76.02	76.48	Annual checkup	678	73
76.97	76.17	76.59	Annual checkup	1,061	74
77.10	76.06	76.60	Annual checkup	721	75
77.14	76.28	76.72	Annual checkup	1,001	76
77.34	76.36	76.87	Annual checkup	666	77
77.25	76.42	76.83	Annual checkup	1,025	78
77.42	76.64	77.05	Annual checkup	698	79
77.40	76.62	77.01	Annual checkup	1,024	80
77.44	76.56	77.01	Annual checkup	663	81
77.47	76.73	77.10	Annual checkup	983	82
77.57	76.70	77.14	Annual checkup	657	83
77.59	76.84	77.23	Annual checkup	906	84
77.60	76.68	77.12	Annual checkup	629	85
77.55	76.65	77.12	Annual checkup	984	86
77.54	76.69	77.11	Annual checkup	619	87
77.85	77.17	77.51	Annual checkup	911	88
77.71	76.73	77.22	Annual checkup	648	89
77.84	76.96	77.40	Annual checkup	941	90
78.03	77.07	77.55	Annual checkup	578	91
78.03	77.10	77.57	Annual checkup	878	92
77.95	77.04	77.49	Annual checkup	589	93
77.98	76.88	77.43	Annual checkup	794	94
78.49	77.38	77.94	Annual checkup	532	95
78.56	77.55	78.05	Annual checkup	761	96
78.69	77.23	77.94	Annual checkup	536	97
78.79	77.53	78.16	Annual checkup	725	98
79.20	77.82	78.56	Annual checkup	549	99
79.66	77.53	78.70	Annual checkup	682	100
75.95	73.21	74.77	Dental visit	693	1
74.95	71.66	73.03	Dental visit	779	2
74.03	69.83	71.73	Dental visit	587	3
73.10	69.50	71.27	Dental visit	925	4
72.41	67.16	69.78	Dental visit	636	5
71.85	66.40	69.10	Dental visit	979	6
72.28	68.03	69.95	Dental visit	607	7
71.49	67.30	69.14	Dental visit	915	8
70.93	66.28	68.51	Dental visit	677	9
71.20	65.54	68.13	Dental visit	1,000	10
70.92	66.74	68.66	Dental visit	598	11
71.10	65.61	68.31	Dental visit	1,019	12
70.67	64.96	67.82	Dental visit	693	13
69.96	65.82	67.76	Dental visit	1,007	14
69.56	65.06	67.17	Dental visit	656	15
68.75	64.39	66.47	Dental visit	1,054	16
69.25	63.74	66.50	Dental visit	684	17
68.72	64.09	66.41	Dental visit	1,033	18
68.01	62.54	65.35	Dental visit	702	19
68.93	63.42	66.35	Dental visit	1,019	20
68.80	64.71	66.89	Dental visit	655	21
68.55	64.87	66.88	Dental visit	1,098	22
68.13	64.36	66.42	Dental visit	652	23
68.45	64.67	66.80	Dental visit	1,050	24
68.55	65.97	67.31	Dental visit	679	25
67.72	65.33	66.54	Dental visit	1,028	26
68.37	64.46	66.58	Dental visit	678	27
67.19	64.49	65.94	Dental visit	1,029	28
67.13	63.11	65.31	Dental visit	659	29
66.91	63.97	65.49	Dental visit	1,112	30
67.01	64.12	65.58	Dental visit	668	31
66.85	64.91	65.87	Dental visit	1,010	32
66.15	64.07	65.12	Dental visit	689	33
66.43	64.52	65.46	Dental visit	1,053	34
66.47	64.56	65.50	Dental visit	672	35
65.61	63.65	64.60	Dental visit	1,098	36
65.35	63.25	64.33	Dental visit	730	37
65.20	63.21	64.22	Dental visit	1,031	38
65.94	63.57	64.81	Dental visit	620	39
65.01	62.95	63.98	Dental visit	995	40
64.49	62.47	63.45	Dental visit	709	41
64.73	62.72	63.73	Dental visit	1,045	42
64.07	62.06	63.06	Dental visit	690	43
64.47	62.63	63.54	Dental visit	1,044	44
63.79	61.68	62.72	Dental visit	689	45
64.37	61.92	63.18	Dental visit	1,008	46
64.27	62.43	63.32	Dental visit	655	47
63.22	61.36	62.31	Dental visit	1,070	48
63.60	61.77	62.69	Dental visit	652	49
62.95	61.06	61.98	Dental visit	1,066	50
63.09	61.02	62.02	Dental visit	667	51
62.68	60.73	61.70	Dental visit	1,106	52
62.23	60.18	61.18	Dental visit	721	53
61.92	59.70	60.81	Dental visit	1,047	54
61.91	59.65	60.80	Dental visit	670	55
61.76	59.66	60.68	Dental visit	1,069	56
61.68	59.81	60.75	Dental visit	664	57
61.60	59.55	60.60	Dental visit	1,046	58
60.95	58.48	59.74	Dental visit	756	59
60.71	58.91	59.80	Dental visit	1,056	60
60.96	58.76	59.82	Dental visit	672	61
59.68	57.43	58.55	Dental visit	1,107	62
60.09	57.55	58.83	Dental visit	679	63
59.80	57.28	58.60	Dental visit	1,061	64
59.44	56.75	58.17	Dental visit	699	65
60.07	57.81	59.01	Dental visit	1,041	66
59.18	56.90	58.09	Dental visit	696	67
58.98	57.04	57.99	Dental visit	1,028	68
59.27	57.22	58.28	Dental visit	679	69
58.04	56.06	57.05	Dental visit	1,030	70
58.22	55.94	57.06	Dental visit	711	71
58.05	55.98	56.99	Dental visit	1,040	72
57.70	55.43	56.57	Dental visit	678	73
56.97	55.23	56.10	Dental visit	1,061	74
57.37	55.13	56.25	Dental visit	721	75
56.19	54.20	55.22	Dental visit	1,001	76
56.62	54.18	55.43	Dental visit	666	77
55.97	54.23	55.16	Dental visit	1,025	78
56.19	54.31	55.21	Dental visit	698	79
56.09	54.19	55.15	Dental visit	1,024	80
55.11	52.96	54.09	Dental visit	663	81
54.97	53.06	54.04	Dental visit	983	82
53.68	51.27	52.51	Dental visit	657	83
54	52.03	53.06	Dental visit	906	84
53.16	50.52	51.88	Dental visit	629	85
52.58	50.51	51.60	Dental visit	984	86
52.83	50.87	51.82	Dental visit	619	87
51.78	49.96	50.88	Dental visit	911	88
50.53	48.08	49.35	Dental visit	648	89
51.08	49.04	50.09	Dental visit	941	90
50.20	47.56	48.95	Dental visit	578	91
49.48	47.27	48.38	Dental visit	878	92
48.71	46.46	47.55	Dental visit	589	93
46.61	44.20	45.45	Dental visit	794	94
46.74	44.23	45.52	Dental visit	532	95
45.02	42.81	43.95	Dental visit	761	96
44.18	41.51	42.78	Dental visit	536	97
42.57	38.99	40.94	Dental visit	725	98
42.64	39.48	41.10	Dental visit	549	99
40.76	37.25	39.14	Dental visit	682	100

The dental line falls across the whole axis and the checkup line rises by far less. Each point is the population-weighted mean prevalence in the tracts at one percentile of the index, with a 95% interval from a bootstrap over counties.Note: PLACES values are modeled estimates. They are built from BRFSS survey responses with census and American Community Survey inputs (county poverty, the age, sex, race and ethnicity of each tract's residents, and education), with state and county random effects, and the Area Deprivation Index is built from American Community Survey data too, so part of each gradient here is mechanical. Within a county, tract values differ through the demographic composition of tracts. The tract file has no intervals; the bands are 95% intervals for the weighted mean from a bootstrap over counties (replicates and seed in the methods note).Note: PLACES 2024 release: BRFSS 2022 for most measures and BRFSS 2021 for blood pressure, blood pressure medicine, high cholesterol and cholesterol screening. Values are crude prevalence among adults, not age-adjusted, so differences in age structure move them.Source: CDC PLACES 2024 release (BRFSS 2022) and Area Deprivation Index 2023; modeled estimates, population-weighted (adults in each tract)

The same split appears across a wider ledger of care (Figure 4). Among women ages 50 to 74, mammography is 7.0 (95% CI 6.3 to 7.8) points lower in the most deprived tenth. Cholesterol screening is 6.9 (95% CI 6.2 to 7.5) points lower, and colorectal cancer screening among adults ages 45 to 75 is 6.2 (95% CI 4.4 to 8.2) points lower. Among adults ages 18 to 64, the share without health insurance is 17.4% (95% CI 16.1% to 18.9%) against 6.3% (95% CI 5.7% to 6.8%), 11.1 (95% CI 9.7 to 12.7) points higher, and the share of adults without reliable transportation is 9.7 (95% CI 9.0 to 10.5) points higher. Among adults with high blood pressure, the share taking medicine for it is 5.9 (95% CI 4.8 to 6.7) points higher, and the checkup, as above, is 3.6 points higher. Tract means weight each tract by all its adults, including for the measures that cover only some ages, because the file carries no population for them. The figure groups the measures as checkup and treatment, dental visit and screening, and barriers. The grouping is this book's, since PLACES files the checkup, blood pressure medicine, the dental visit and insurance together under prevention. Within it, the dental visit and the screening tests fall with deprivation, and the checkup and blood pressure medicine rise.

Figure 4

In the most deprived tenth of tracts, the dental visit and screening tests are less common by 6.2 to 24.4 points and barriers to care are more common by 9.7 and 11.1 points

Difference in the share of adults, most deprived tenth of tracts minus least deprived tenth, percentage points, eight measures of care, 2021 and 2022

Checkup and treatment
Dental visit and screening
Barriers

Show data

Data for In the most deprived tenth of tracts, the dental visit and screening tests are less common by 6.2 to 24.4 points and barriers to care are more common by 9.7 and 11.1 points
Measure	Group	Least deprived tenth (%)	Most deprived tenth (%)	Difference (points)	Lower limit of the 95% interval	Upper limit of the 95% interval	Tracts in the most deprived tenth
Annual checkup	Checkup and treatment	74.2	77.8	3.6	2.4	4.6	8,213
Blood pressure medicine, adults with high blood pressure	Checkup and treatment	73.6	79.5	5.9	4.8	6.7	7,946
Dental visit	Dental visit and screening	70.3	45.8	−24.4	−26.5	−22.5	8,213
Mammography, women ages 50 to 74	Dental visit and screening	78.8	71.7	−7.0	−7.8	−6.3	8,213
Cholesterol screening	Dental visit and screening	87.9	81.0	−6.9	−7.5	−6.3	7,946
Colorectal cancer screening, ages 45 to 75	Dental visit and screening	65.3	59.1	−6.2	−8.3	−4.4	8,213
No reliable transportation	Barriers	6.1	15.9	9.7	9.0	10.6	6,348
No health insurance, ages 18 to 64	Barriers	6.3	17.4	11.1	9.7	12.8	8,213

The four dots for the dental visit and screening lie left of zero, the two barrier dots lie right of zero, and the checkup and blood pressure medicine dots lie right of zero by 3.6 and 5.9 points. Each dot is a difference between population-weighted tenth means with a 95% interval from a bootstrap over counties.Note: Blood pressure medicine is the share of adults with high blood pressure who take medicine for it, and blood pressure medicine and cholesterol screening are BRFSS 2021 estimates; the other measures are BRFSS 2022. The transportation question was asked in only some states, so that row covers fewer tracts. The grouping into checkup and treatment, dental visit and screening, and barriers is this book's: PLACES files the checkup, blood pressure medicine, the dental visit and insurance together under prevention. Some measures cover only some ages (insurance, mammography, colorectal screening), and tract means weight each tract by all its adults.Note: PLACES values are modeled estimates. They are built from BRFSS survey responses with census and American Community Survey inputs (county poverty, the age, sex, race and ethnicity of each tract's residents, and education), with state and county random effects, and the Area Deprivation Index is built from American Community Survey data too, so part of each gradient here is mechanical. Within a county, tract values differ through the demographic composition of tracts. The tract file has no intervals; the bands are 95% intervals for the weighted mean from a bootstrap over counties (replicates and seed in the methods note).Source: CDC PLACES 2024 release (BRFSS 2021 and 2022) and Area Deprivation Index 2023; modeled estimates, population-weighted (adults in each tract)

Within states and counties the checkup slope stays near zero

The national checkup difference could reflect where deprived tracts are, because the checkup rate differs across states. Figure 5 compares four ways of drawing the slope across 82,779 tracts that have an ADI rank, both measures and the three census shares. Across all tracts, the checkup rate rises +0.41 (95% CI 0.29 to 0.54) points for each ten-point step in the ADI percentile. Within states, with a separate baseline for each state (state fixed effects), the slope is −0.01 (95% CI −0.08 to 0.05), and within counties it is −0.27 (95% CI −0.35 to −0.19), a decline. Holding the tract's shares of older, Black and Hispanic residents fixed within states gives −0.05 (95% CI −0.10 to 0.01). The dental slope is −2.37 (95% CI −2.66 to −2.08) across all tracts, −2.97 (95% CI −3.14 to −2.80) within states, −3.86 (95% CI −3.99 to −3.73) within counties and −2.38 (95% CI −2.51 to −2.24) within states with the controls. Within a state or a county the checkup slope is at most 0.27 in size, and the smallest dental slope is 8.8 times as large.

Figure 5

The checkup slope is within 0.5 points of zero in all four specifications, and the dental slope is between −2.37 and −3.86 points

Slope of tract prevalence on the Area Deprivation Index national percentile, points of prevalence per ten percentiles, adults, four specifications, 2022

Annual checkup
Dental visit

Show data

Data for The checkup slope is within 0.5 points of zero in all four specifications, and the dental slope is between −2.37 and −3.86 points
conf_high	conf_low	estimate	measure	n	specification
0.541	0.287	0.414	Annual checkup	82,779	All tracts
−2.08	−2.67	−2.37	Dental visit	82,779	All tracts
0.054	−0.080	−0.013	Annual checkup	82,779	Within states
−2.81	−3.14	−2.97	Dental visit	82,779	Within states
−0.190	−0.348	−0.269	Annual checkup	82,779	Within counties
−3.73	−3.99	−3.86	Dental visit	82,779	Within counties
0.006	−0.100	−0.047	Annual checkup	82,779	Within states, with age and race controls
−2.24	−2.51	−2.38	Dental visit	82,779	Within states, with age and race controls

The checkup dots lie close to the zero line in every row and the dental dots lie well to its left in every row, so the contrast does not depend on how places are compared. Each dot is a population-weighted slope across tracts with a 95% interval that uses counties as clusters; the rows differ in what is held fixed.Note: Within states and within counties, the comparison is between tracts of one state or county, with a separate baseline for each. The last row also holds constant the tract shares of residents who are ages 65 and over, Black alone and Hispanic. The standard error treats the tracts of a county as one cluster.Note: PLACES values are modeled estimates. They are built from BRFSS survey responses with census and American Community Survey inputs (county poverty, the age, sex, race and ethnicity of each tract's residents, and education), with state and county random effects, and the Area Deprivation Index is built from American Community Survey data too, so part of each gradient here is mechanical. Within a county, tract values differ through the demographic composition of tracts. The tract file has no intervals; the bands are 95% intervals for the weighted mean from a bootstrap over counties (replicates and seed in the methods note).Source: CDC PLACES 2024 release (BRFSS 2022) and Area Deprivation Index 2023; modeled estimates, population-weighted (adults in each tract)

Fitting the slope separately in each state gives the same contrast (Figure 6). The dental slope is negative in 51 of 51 states and has an interval below zero in 50, with a median of −3.2 points per ten-point step. It is within 0.5 points of zero in 0 states. The checkup slope is within 0.5 points of zero in 42 states, with a median of +0.03. It is not zero everywhere. The interval lies below zero in 18 states, above zero in 10 and across zero in 23. The largest estimate is +1.7 (95% CI 1.3 to 2.1) in the District of Columbia, which is a single county, so its interval is not clustered. Every state has at least 158 tracts, above the floor of 60 tracts for entering the comparison, so none is dropped.

Figure 6

The dental visit rate falls with deprivation in all 51 states, and the checkup slope is within 0.5 points of zero in 42

Slope of tract prevalence on the Area Deprivation Index national percentile within each state, points of prevalence per ten percentiles, adults, 2022

Annual checkup

Dental visit

Points of prevalence per ten-point step in the ADI national percentile

Show data

Data for The dental visit rate falls with deprivation in all 51 states, and the checkup slope is within 0.5 points of zero in 42
conf_high	conf_low	estimate	measure	n	state
0.287	−0.038	0.124	Annual checkup	1,421	AL
−3.48	−4.00	−3.74	Dental visit	1,421	AL
−0.261	−0.862	−0.561	Annual checkup	172	AK
−3.07	−4.31	−3.69	Dental visit	172	AK
−0.227	−0.620	−0.423	Annual checkup	1,723	AZ
−3.07	−3.86	−3.46	Dental visit	1,723	AZ
0.808	0.004	0.406	Annual checkup	818	AR
−3.02	−4.22	−3.62	Dental visit	818	AR
−0.276	−0.857	−0.566	Annual checkup	8,982	CA
−3.36	−4.11	−3.74	Dental visit	8,982	CA
0.182	−0.677	−0.248	Annual checkup	1,420	CO
−2.96	−3.81	−3.38	Dental visit	1,420	CO
−0.135	−0.604	−0.369	Annual checkup	872	CT
−2.67	−4.46	−3.57	Dental visit	872	CT
−0.197	−0.605	−0.401	Annual checkup	253	DE
−3.36	−4.10	−3.73	Dental visit	253	DE
2.11	1.32	1.71	Annual checkup	201	DC
−5.57	−7.38	−6.47	Dental visit	201	DC
0.188	−0.244	−0.028	Annual checkup	5,034	FL
−2.59	−3.24	−2.92	Dental visit	5,034	FL
0.604	0.140	0.372	Annual checkup	2,767	GA
−3.09	−3.42	−3.26	Dental visit	2,767	GA
−0.061	−0.477	−0.269	Annual checkup	414	HI
−2.46	−3.31	−2.88	Dental visit	414	HI
−0.009	−1.13	−0.567	Annual checkup	453	ID
−1.34	−3.51	−2.43	Dental visit	453	ID
0.631	−0.232	0.199	Annual checkup	3,239	IL
−2.34	−3.09	−2.71	Dental visit	3,239	IL
−0.035	−0.262	−0.149	Annual checkup	1,671	IN
−3.12	−3.83	−3.47	Dental visit	1,671	IN
0.241	−0.148	0.047	Annual checkup	887	IA
−2.41	−3.12	−2.77	Dental visit	887	IA
−0.075	−0.353	−0.214	Annual checkup	811	KS
−2.67	−3.47	−3.07	Dental visit	811	KS
−0.028	−0.136	−0.082	Annual checkup	1,285	KY
−3.35	−3.87	−3.61	Dental visit	1,285	KY
0.488	0.144	0.316	Annual checkup	1,352	LA
−3.52	−4.38	−3.95	Dental visit	1,352	LA
0.492	−0.013	0.239	Annual checkup	399	ME
−2.43	−2.95	−2.69	Dental visit	399	ME
0.577	0.043	0.310	Annual checkup	1,451	MD
−3.08	−3.73	−3.41	Dental visit	1,451	MD
0.696	−0.341	0.177	Annual checkup	1,576	MA
−2.09	−3.89	−2.99	Dental visit	1,576	MA
0.273	−0.206	0.034	Annual checkup	2,872	MI
−2.62	−3.82	−3.22	Dental visit	2,872	MI
0.025	−0.332	−0.154	Annual checkup	1,492	MN
−2.27	−3.09	−2.68	Dental visit	1,492	MN
0.600	0.173	0.387	Annual checkup	867	MS
−1.43	−1.88	−1.66	Dental visit	867	MS
0.092	−0.300	−0.104	Annual checkup	1,641	MO
−3.25	−3.68	−3.47	Dental visit	1,641	MO
0.947	−0.482	0.232	Annual checkup	316	MT
−1.91	−2.95	−2.43	Dental visit	316	MT
−0.204	−0.497	−0.350	Annual checkup	547	NE
−2.60	−3.78	−3.19	Dental visit	547	NE
−0.251	−0.963	−0.607	Annual checkup	767	NV
−3.17	−4.51	−3.84	Dental visit	767	NV
−0.002	−1.06	−0.530	Annual checkup	346	NH
−2.23	−3.10	−2.67	Dental visit	346	NH
0.441	−0.353	0.044	Annual checkup	2,155	NJ
−2.61	−4.18	−3.40	Dental visit	2,155	NJ
−0.335	−0.969	−0.652	Annual checkup	595	NM
−3.23	−4.19	−3.71	Dental visit	595	NM
0.446	−0.068	0.189	Annual checkup	5,196	NY
0.164	−1.22	−0.526	Dental visit	5,196	NY
0.287	0.009	0.148	Annual checkup	2,625	NC
−2.88	−3.25	−3.06	Dental visit	2,625	NC
0.909	0.246	0.577	Annual checkup	225	ND
−1.50	−2.73	−2.11	Dental visit	225	ND
0.211	−0.126	0.043	Annual checkup	3,131	OH
−3.34	−3.77	−3.56	Dental visit	3,131	OH
−0.009	−0.331	−0.170	Annual checkup	1,186	OK
−3.65	−4.21	−3.93	Dental visit	1,186	OK
0.642	−0.513	0.065	Annual checkup	990	OR
−2.56	−3.59	−3.07	Dental visit	990	OR
0.236	−0.079	0.079	Annual checkup	3,374	PA
−2.40	−3.33	−2.86	Dental visit	3,374	PA
−0.463	−0.992	−0.727	Annual checkup	244	RI
−3.26	−5.87	−4.56	Dental visit	244	RI
0.431	0.043	0.237	Annual checkup	1,295	SC
−2.89	−3.56	−3.22	Dental visit	1,295	SC
0.101	−0.535	−0.217	Annual checkup	242	SD
−2.33	−3.80	−3.07	Dental visit	242	SD
0.378	−0.036	0.171	Annual checkup	1,669	TN
−2.51	−3.76	−3.14	Dental visit	1,669	TN
0.009	−0.387	−0.189	Annual checkup	6,789	TX
−3.33	−3.95	−3.64	Dental visit	6,789	TX
0.010	−0.821	−0.405	Annual checkup	705	UT
−2.99	−3.90	−3.45	Dental visit	705	UT
0.796	−0.182	0.307	Annual checkup	192	VT
−1.99	−2.73	−2.36	Dental visit	192	VT
0.495	0.226	0.361	Annual checkup	2,141	VA
−2.27	−2.67	−2.47	Dental visit	2,141	VA
−0.002	−0.490	−0.246	Annual checkup	1,757	WA
−2.96	−3.68	−3.32	Dental visit	1,757	WA
0.392	−0.083	0.154	Annual checkup	543	WV
−2.31	−3.79	−3.05	Dental visit	543	WV
0.676	−0.430	0.123	Annual checkup	1,520	WI
−2.36	−4.15	−3.25	Dental visit	1,520	WI
−0.048	−0.920	−0.484	Annual checkup	158	WY
−1.72	−2.84	−2.28	Dental visit	158	WY

Every dental dot lies left of zero, and the checkup dots cluster around zero on the same scale. Each dot is one state's population-weighted slope across its tracts, with a 95% interval that uses counties as clusters; rows are sorted from the lowest slope to the highest within each panel.Note: States are shown by their postal codes. Delaware, Hawaii and the District of Columbia have too few counties for cluster-robust errors, so their intervals use HC3 errors, and the District of Columbia is a single county. Every state has at least 158 tracts, above the floor of 60, so none is dropped.Note: PLACES values are modeled estimates. They are built from BRFSS survey responses with census and American Community Survey inputs (county poverty, the age, sex, race and ethnicity of each tract's residents, and education), with state and county random effects, and the Area Deprivation Index is built from American Community Survey data too, so part of each gradient here is mechanical. Within a county, tract values differ through the demographic composition of tracts. The tract file has no intervals; the bands are 95% intervals for the weighted mean from a bootstrap over counties (replicates and seed in the methods note).Source: CDC PLACES 2024 release (BRFSS 2022) and Area Deprivation Index 2023; modeled estimates, population-weighted (adults in each tract)

None of this removes the model's inputs. Within a county, tract values differ only through demographic composition, so a slope within counties shows how the model maps composition into prevalence. What the comparison does show is that two measures that share every input, the checkup and the dental visit, have slopes that differ in size by a factor of 8.8 or more in every specification that holds the state or county fixed.

The supply of providers is thinner in deprived counties

In 1971 the physician Julian Tudor Hart observed that the availability of good medical care tends to vary inversely with the need for it in the population served.[3] Read descriptively, the inverse care law predicts that counties with more deprivation, where measures of illness are higher, have fewer providers for their residents. County Health Rankings counts providers by county: primary care physicians in 2021, dentists in 2022 and mental health providers in 2023.[4] Primary care physicians are practicing non-federal physicians in general practice, family medicine, internal medicine and pediatrics. Dentists are those with a National Provider Identifier. Mental health providers include psychiatrists, psychologists, social workers, counselors and therapists, and nurse practitioners who specialize in mental health. Across the 3,143 counties there is one primary care physician for every 1,334 residents, one dentist for every 1,361 and one mental health provider for every 319.

Ranking 3,128 counties on a county ADI, the population-weighted mean of tract ranks, and pooling each tenth, residents per primary care physician rise from 1,159 (95% CI 1,093 to 1,205) in the least deprived tenth of counties to 2,730 (95% CI 2,452 to 3,018) in the most deprived, a ratio of 2.4 (95% CI 2.1 to 2.6). For dentists the figures are 1,131 and 3,055, a ratio of 2.7 (95% CI 2.3 to 3.1). For mental health providers they are 250 and 550, a ratio of 2.2 (95% CI 1.5 to 3.5), although the most deprived tenth has fewer residents per provider than the ninth and its interval is wide (Figure 7). Weighted by county residents, the county ADI correlates −0.41 (95% CI −0.46 to −0.35) with physicians per hundred thousand residents, −0.52 (95% CI −0.61 to −0.41) with dentists and −0.42 (95% CI −0.53 to −0.26) with mental health providers. Counting each county once, the correlations are −0.37 (95% CI −0.43 to −0.32), −0.35 (95% CI −0.45 to −0.27) and −0.33 (95% CI −0.44 to −0.23), smaller in size but still negative.

Figure 7

Residents per primary care physician rise from 1,159 to 2,730 and per dentist from 1,131 to 3,055 between the least and most deprived tenths of counties

Residents per provider, pooled over the counties in each tenth of counties ranked on the county Area Deprivation Index, providers counted in 2021 (physicians), 2022 (dentists) and 2023 (mental health providers)

Show data

Data for Residents per primary care physician rise from 1,159 to 2,730 and per dentist from 1,131 to 3,055 between the least and most deprived tenths of counties
Provider	County deprivation decile	Residents per provider	Lower limit of the 95% interval	Upper limit of the 95% interval	Providers	Residents	Counties	Counties with no provider in the decile
Primary care physicians	1	1,159	1,093	1,205	113,749	131,811,420	312	7
Primary care physicians	2	1,335	1,221	1,449	46,027	61,434,044	313	5
Primary care physicians	3	1,389	1,286	1,511	30,365	42,189,945	313	7
Primary care physicians	4	1,411	1,309	1,512	22,741	32,087,932	312	10
Primary care physicians	5	1,529	1,365	1,737	13,522	20,679,797	314	17
Primary care physicians	6	1,656	1,458	1,877	8,739	14,471,394	312	29
Primary care physicians	7	1,894	1,660	2,148	5,756	10,903,268	313	19
Primary care physicians	8	2,083	1,905	2,249	4,293	8,942,931	315	38
Primary care physicians	9	2,593	2,394	2,828	2,130	5,522,704	312	35
Primary care physicians	10	2,730	2,452	3,018	1,403	3,830,042	312	53
Dentists	1	1,131	1,074	1,232	116,844	132,162,193	312	10
Dentists	2	1,439	1,304	1,583	43,139	62,071,203	313	4
Dentists	3	1,425	1,351	1,552	29,869	42,550,714	313	13
Dentists	4	1,494	1,388	1,624	21,574	32,224,541	312	11
Dentists	5	1,622	1,473	1,848	12,745	20,677,282	314	21
Dentists	6	1,776	1,586	1,984	8,145	14,463,884	312	27
Dentists	7	1,949	1,775	2,169	5,585	10,883,473	313	22
Dentists	8	2,454	2,196	2,718	3,638	8,928,681	315	30
Dentists	9	2,713	2,533	2,920	2,026	5,496,600	312	31
Dentists	10	3,055	2,638	3,533	1,240	3,788,578	312	58
Mental health providers	1	250	221	307	528,315	132,162,193	312	2
Mental health providers	2	351	290	415	176,791	62,071,203	313	2
Mental health providers	3	372	312	436	114,486	42,550,714	313	11
Mental health providers	4	364	310	425	88,447	32,224,541	312	9
Mental health providers	5	402	339	517	51,406	20,677,282	314	16
Mental health providers	6	463	363	604	31,271	14,463,884	312	26
Mental health providers	7	483	407	612	22,524	10,883,473	313	18
Mental health providers	8	551	426	746	16,210	8,928,681	315	32
Mental health providers	9	641	505	837	8,572	5,496,600	312	38
Mental health providers	10	550	382	882	6,883	3,788,578	312	52

The physician and dentist lines climb toward the more deprived deciles, and the mental health line is lower and rises less evenly, ending in a dip at the most deprived decile. Each point is the residents of the counties in a decile divided by their providers, with a 95% interval from a bootstrap over states, so a higher value means fewer providers for each resident.Note: Counties with no recorded provider stay in: they add residents and no providers. County Health Rankings leaves their published ratio blank above a population cutoff that differs by provider type and reports a rate of 0 below it, and the first edition of this chapter dropped them. Primary care physicians are practicing non-federal physicians under age 75 in general practice, family medicine, internal medicine and pediatrics; dentists are those with a National Provider Identifier; mental health providers include psychiatrists, psychologists, social workers, counselors, therapists and mental health nurse practitioners. Providers are counted where they practice, not by the care patients receive.Note: Deciles hold about the same number of counties, 15 small counties with no deprivation rank are outside them (so the counts of counties with no provider in the table are smaller than the counts in the text, which cover all counties), and Puerto Rico is not covered.Source: County Health Rankings 2024 (provider counts from AMA, CMS and NPPES files, 2021-2023) and Area Deprivation Index 2023; full counts, pooled ratios

Residents per provider here is a county group's residents divided by its providers, so a county with no provider adds residents and no providers. County Health Rankings leaves the ratio blank for a county with no provider when its population is above 2,000 for physicians, 4,000 for dentists and 1,000 for mental health providers, and reports a rate of zero for smaller counties. The first edition of this book dropped the blank ones and averaged the county ratios. That average is larger in every tenth for all three provider types, because small counties with one or two providers have very large ratios.

Counties with no provider stay in these figures. Among all 3,143 counties there are 232 with no recorded primary care physician, 239 with no dentist and 216 with no mental health provider; the 15 counties without a deprivation rank are outside the tenths. Figure 8 maps residents per mental health provider. In 275 counties the ratio is above 3,200, and 91.6% of those counties are majority rural. Most lie in the South and the Midwest (96.0%). The 216 gray counties have no recorded provider, so the ratio is undefined for them and their supply is the thinnest of all.

Figure 8

Residents per mental health provider exceed 3,200 in 275 counties, and 91.6% of those counties have a mostly rural population

Residents per mental health provider by county, providers counted in 2023, on a scale that doubles at each step

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Residents per mental health provider, 2023

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Hover or tap a county for its value, or search by name. Zoom with the buttons on the map, then drag to move it.

Counties toward the high end of the key have few providers for their residents, and 216 gray counties have none recorded, so their ratio is undefined and they are the thinnest supply of all. The map plots each county's residents divided by its mental health providers; hover for the counts.Note: Gray counties have no mental health provider recorded in 2023; County Health Rankings leaves the ratio blank for them. They are not missing data, and their tooltip says so. Puerto Rico is not drawn. Alaska is drawn, and Connecticut appears under its eight legacy counties.Note: Providers are counted where they practice and each county's residents are the denominator, so a county next to a large city can look thin while its residents are served across the county line.Source: County Health Rankings 2024 (CMS National Provider Identifier file, 2023); full counts, county ratios

Two other county measures move with the same index. Preventable hospital stays, admissions for conditions that outpatient care can often manage, were 2,370 (95% CI 2,188 to 2,599) per hundred thousand Medicare enrollees in the least deprived tenth of counties and 4,012 (95% CI 3,608 to 4,435) in the most deprived, and the county ADI correlates +0.46 (95% CI 0.31 to 0.56) with the rate, +0.38 (95% CI 0.30 to 0.46) counting each county once. The County Health Rankings food environment index, a county score that combines access to healthy food with food insecurity and on which a higher value is better, falls from 8.6 (95% CI 8.5 to 8.8) to 6.1 (95% CI 5.7 to 6.6) across the same tenths, and correlates −0.66 (95% CI −0.74 to −0.59) with the county ADI, −0.51 (95% CI −0.58 to −0.45) counting each county once.

Evidence on coverage and capacity

Causal evidenceRandomized lottery; difference-in-differences

Coverage expansions and community health centers

The gradients above describe places. Four studies ask whether adding coverage or capacity changes the use of care and health for the people who gain it.

In 2008 Oregon drew names by lottery for the chance to apply for Medicaid, so the people selected could be compared with the people who were not. In the first year, Medicaid coverage raised the use of health care, including primary and preventive care, lowered out-of-pocket medical spending and medical debt, and improved self-reported health.[5] At the later follow-up, coverage raised the use of preventive services, raised the detection and management of diabetes and lowered the rate of positive screens for depression, but produced no significant change in measured blood pressure, cholesterol or glycated hemoglobin.[6]

Miller, Johnson and Wherry linked survey records to death records and compared near-elderly adults in states that expanded Medicaid under the Affordable Care Act with those in states that did not, before and after the expansions. This difference-in-differences design, checked with an event study of the years before the expansions, found lower annual mortality in the expansion states.[7] Bailey and Goodman-Bacon applied a difference-in-differences event study to the 1965 to 1974 rollout of community health centers, comparing counties that opened a center earlier with counties that opened one later, and found lower mortality among older adults in the counties that opened a center earlier.[8]

The Oregon and Medicaid studies change insurance coverage, which is not the same as changing the number of dentists or mental health providers in a county, and the health center study changes clinic capacity. The estimates apply to the people and years each study covers, and none of the four measures what adding providers to the counties in the figures would do.

What these data cannot show

PLACES values are modeled estimates, and the tract file has no intervals, so the bands in this chapter describe the sampling of counties and not the model's own uncertainty. The model and the Area Deprivation Index draw on overlapping census inputs, which builds part of each gradient into the numbers, and the data cannot say how much. The values are crude prevalence among adults and are not adjusted for age, and CDC advises against using them to rank the overall health of an area or to track change at the local level, which this chapter does not do.[9] The slopes and coefficients compare tracts and say nothing about the behavior of a person. Within a county the model gives tracts different values only through their demographic composition, so the comparison of the checkup and the dental visit within counties cannot separate behavior from composition at all.

The checkup measure is the share of adults who report a routine checkup in the past year, and the dental measure is the share who report a dental visit. Neither says what happened at the visit, whether the care was timely or whether it was affordable. Dental coverage is a separate matter from medical coverage, and the chapter has no measure of it.

Provider counts locate providers where they practice and divide by residents. They do not measure capacity, wait times or whether a provider accepts a patient's insurance, and county averages hide deserts inside counties and care that crosses county lines. The three provider counts come from different years, 2021 to 2023, and the PLACES estimates describe 2022 on an index built from 2019 to 2023 census data, so the sources do not describe one moment. Connecticut appears in PLACES under planning-region codes, which serve as its counties for the bootstrap, and in County Health Rankings under its eight legacy counties. 15 small counties have no deprivation rank and are left out of the tenths in the provider figures, and Puerto Rico is covered by neither PLACES nor the maps.

The association between supply and deprivation could run in either direction or through a third factor such as rurality, and the figures do not separate them. The studies in the box concern coverage and clinic capacity, and none of them estimates how a change in the supply of providers would alter the county gradients.

Data sources

CDC PLACESCDC PLACES 2024 release, census tracts: modeled prevalence among adults for 40 measures (BRFSS 2022; 2021 for four measures), crude prevalenceYears: 2024 release (tracts); 2025 release (ZCTAs, 2023 data year) · Weights: adult population of each tract (PLACES) · License: Public domain (CDC, U.S. Department of Health and Human Services)
Area Deprivation IndexNeighborhood Atlas Area Deprivation Index 2023, national percentile, tract and county (county mean of tract ranks)Years: 2023 release (version 4.0.1; built on ACS 2019-2023) · Weights: adult population of each tract; ACS 2019-2023 population for county means · License: Free for non-commercial use; cite the Neighborhood Atlas and Kind and Buckingham
County Health RankingsCounty Health Rankings 2024: provider counts (physicians 2021, dentists 2022, mental health providers 2023), preventable hospital stays 2021, food environment index 2019 and 2021, percent ruralYears: 2024 release · Weights: pooled ratios of counts; county population for county means and correlations · License: CC BY 4.0 (University of Wisconsin Population Health Institute)
American Community SurveyACS 2019-2023 tracts: median household income and the shares of residents who are ages 65 and over, Black alone and HispanicYears: 2019-2023 (5-year) · Weights: none (controls and the income axis) · License: Public domain (U.S. Census Bureau)

All data sources

Methods

This chapter compares adults in tenths of census tracts ranked by the Area Deprivation Index 2023, and counties ranked the same way, on health behaviors, access to care and provider supply. The tract values are model-based estimates from CDC PLACES, built from BRFSS 2022 (2021 for four measures) with poverty, demographic and education inputs, not direct counts, and the staged tract file has no intervals. Outcome, deprivation and provider counts come from different years (provider counts are for 2021 to 2023). Tracts and counties without a deprivation rank are left out (741 tracts and 15 small counties), and a county with no recorded provider adds residents and no providers to a provider ratio. Means are weighted by the tract's adult population.

How tract prevalence is estimated

Tract prevalence is CDC PLACES, 2024 release, crude prevalence among adults: model-based estimates built from BRFSS 2022 (2021 for blood pressure, blood pressure medicine, high cholesterol and cholesterol screening) with county poverty, the age, sex, race and ethnicity of each tract's residents and education from the American Community Survey and the census, and state and county random effects, so that within a county tract values differ through demographic composition.

The staged tract file has no intervals.

Figures explained here: Figure 1, Figure 3 and Figure 4

How tracts are ranked, grouped and weighted

Deprivation is the Area Deprivation Index 2023 national percentile (1 least, 100 most deprived), and 741 tracts have no rank and are left out. Tenths hold 8,118 to 8,511 tracts (tied ranks fall in the same tenth) and twentieths fewer.

Means are weighted by the tract's adult population, including for measures that cover only some ages because the file has no population for them; counting each tract once gives similar differences.

Figures explained here: Figure 1, Figure 3 and Figure 4

How provider supply is measured

Provider supply is from County Health Rankings 2024.

Residents per provider in a group of counties is the group's residents divided by its providers, so a county with no recorded provider adds residents and no providers; the county ratios that County Health Rankings publishes are not used.

Counties are ranked on the county Area Deprivation Index, the mean of the tract percentiles weighted by 2019-2023 population, with Connecticut tracts assigned to its eight legacy counties; 15 small counties have no rank. County percent rural is from the 2020 census.

Figures explained here: Figure 7 and Figure 8

How the map is shaded and what is left out

The map shades residents per mental health provider on a scale that doubles at each step and draws counties with no recorded provider in gray.

Counties are not suppressed anywhere in this chapter, and no tract or county estimate is set to zero.

Figure explained here: Figure 8

How uncertainty is measured

Intervals for means, differences and ratios are percentile intervals from 2,000 draws of whole counties with replacement (seed 12345); differences and ratios share the draws of their two means.

Intervals for pooled ratios, county means and correlations come from the same draw scheme applied to whole states (seed 12345); correlations are reported weighted by county residents and with each county counted once.

How the slopes and the coefficient zoo are fitted

Slopes are population-weighted least-squares fits with cluster-robust errors and t intervals, counties as clusters; fixed effects are absorbed by weighted demeaning and checked against a regression with dummy variables.

The coefficient zoo fits, for each state with at least 60 tracts that have every variable, the tract prevalence of a behavior on the natural log of median household income (ACS 2019-2023) with the shares of residents ages 65 and over, Black alone and Hispanic as controls, and reports the coefficient times the natural log of 2. States with fewer than five counties use HC3 errors.

Figures explained here: Figure 2, Figure 5 and Figure 6

References

Greenlund, Kurt J.; Lu, Hua; Wang, Yan; Matthews, Kevin A.; LeClercq, Jennifer M.; Lee, Benjamin; Carlson, Susan A. (2022). PLACES: Local Data for Better Health. Preventing Chronic Disease 19: 210459. doi:10.5888/pcd19.210459
Kind, Amy J. H.; Buckingham, William R. (2018). Making Neighborhood-Disadvantage Metrics Accessible: The Neighborhood Atlas. New England Journal of Medicine 378(26): 2456-2458. doi:10.1056/NEJMp1802313
Tudor Hart, Julian (1971). The Inverse Care Law. The Lancet 297(7696): 405-412. doi:10.1016/S0140-6736(71)92410-X
University of Wisconsin Population Health Institute (2024). County Health Rankings & Roadmaps Technical Documentation, Version 2. University of Wisconsin Population Health Institute (updated March 18, 2024). www.countyhealthrankings.org/sites/default/files/media/document/2024%20CHRR%20Technical%20Document_1.pdf
Finkelstein, Amy; Taubman, Sarah; Wright, Bill; Bernstein, Mira; Gruber, Jonathan; Newhouse, Joseph P.; Allen, Heidi; Baicker, Katherine; Oregon Health Study Group (2012). The Oregon Health Insurance Experiment: Evidence from the First Year. The Quarterly Journal of Economics 127(3): 1057-1106. doi:10.1093/qje/qjs020
Baicker, Katherine; Taubman, Sarah L.; Allen, Heidi L.; Bernstein, Mira; Gruber, Jonathan H.; Newhouse, Joseph P.; Schneider, Eric C.; Wright, Bill J.; Zaslavsky, Alan M.; Finkelstein, Amy N. (2013). The Oregon Experiment: Effects of Medicaid on Clinical Outcomes. New England Journal of Medicine 368(18): 1713-1722. doi:10.1056/NEJMsa1212321
Miller, Sarah; Johnson, Norman; Wherry, Laura R. (2021). Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data. The Quarterly Journal of Economics 136(3): 1783-1829. doi:10.1093/qje/qjab004
Bailey, Martha J.; Goodman-Bacon, Andrew (2015). The War on Poverty's Experiment in Public Medicine: Community Health Centers and the Mortality of Older Americans. American Economic Review 105(3): 1067-1104. doi:10.1257/aer.20120070
Centers for Disease Control and Prevention (2024). PLACES Frequently Asked Questions: Using the Data. CDC PLACES website, page last reviewed August 29, 2024. www.cdc.gov/places/faqs/using-data/index.html

How to cite

@misc{singh2026healthbehaviorsandthesupplyofcare,
  author = {Singh, Vishal},
  title = {Health behaviors and the supply of care},
  year = {2026},
  url = {https://vishalsingh.org/zipcode/health-behaviors-and-the-supply-of-care},
  note = {In ZIP Code Destiny. Published 9 October 2026.}
}

Same question at another grain

These chapters take up the same axis with a different unit of analysis.

Health behaviors and income
- Chapter 5.2, Health behaviors, person by person Individuals

Measures of health and access rise steeply with deprivation, and the annual checkup rises least

Behaviors and conditions fall with income in every state except binge drinking, which rises

The annual checkup does not follow the gradient that the dental visit does

Within states and counties the checkup slope stays near zero

The supply of providers is thinner in deprived counties

Evidence on coverage and capacity

What these data cannot show

Data sources

Methods

How tract prevalence is estimated

How tracts are ranked, grouped and weighted

How provider supply is measured

How the map is shaded and what is left out

How uncertainty is measured

How the slopes and the coefficient zoo are fitted

References

How to cite

Same question at another grain

Reading paths