Social Determinants of Health

Adults aged ≥ 65 years

Adults aged ≥ 65 years

All people for the same calendar year

Percentage

In 2023, 17.7% of the U.S. population was aged 65 years or older.1 The number of older adults in the U.S. is expected to continue to increase. By 2060 almost a quarter of the U.S. population will be aged 65 years or older.2 Aging increases the risk of chronic diseases such as dementia, heart disease, type 2 diabetes, arthritis, and cancer, which are leading drivers of illness, disability, and death.3 Implementing strategies to promote healthy aging (e.g., promotion of healthy eating and drinking, physical activity, and managing chronic conditions) can help people be as healthy and independent for as long as possible.4

Measure is from table S0101 (variable S0101_C02_030E). Measure is consistent with the ‘Percentage of persons aged 65 and older estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).

All households

Households without broadband of any type

All households for the same calendar year

Time Period of Case Definition

In 2023, 7.9% of households in the United States did not have a broadband internet subscription.5 Residents of rural and tribal areas tend to have lower access to broadband.678 Lack of broadband access can limit educational and economic opportunities, as well as delivery of health care services remotely through telehealth services.7 Telehealth services have been shown to reduce chronic disease risk factors and improve the management of chronic disease conditions, like cardiovascular disease, diabetes, and obesity.9 Providing grants or loans to internet service providers, health care centers, or local governments to expand availability of and lower the costs associated with broadband is one strategy to increase broadband availability.78

Measure is calculated from variables in table S2801. Measure calculation: 100-((S2801_C01_014E/S2801_C01_001E)*100). Measure calculation is consistent with the ‘Broadband access raw value’ provided in the County Health Rankings.

Healthy People 2030 objective: HC/HIT 05. Increase the proportion of adults with broadband internet.

All occupied housing units

Occupied housing units with 1.01 to 1.50 and 1.51 or more occupants per room

All occupied housing units for the same calendar year

Housing instability encompasses a number of challenges, including moving frequently, spending the bulk of household income on housing costs, and crowding.1011 In 2023, 3.5% of occupied housing units experienced crowding (defined as units with more than one person per room).1012 When a rental market becomes unaffordable, people may be forced to move in with others, potentially resulting in crowding.11 Crowding may affect mental health, stress levels, relationships, and sleep, and it may increase the risk of infectious disease.11 Housing subsidies that provide financial assistance to pay rent and public housing assistance programs can help address challenges of housing instability, including crowding.1113

Crowding is not a comprehensive measure of housing instability. Measure is calculated from variables in table DP04. Measure calculation: ((DP04_0078E + DP04_0079E)/DP04_0002E)*100. Measure calculation is consistent with the ‘Percentage of occupied housing units with more people than rooms estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).

All households

Households with annual income less than $75,000 that spend 30% or more of their household income on housing

All households for the same calendar year

Housing instability encompasses a number of challenges, including crowding, moving frequently, or spending the bulk of household income on housing costs.1114 In 2021, 40.6 million households were cost-burdened (spent more than 30% of their income on housing).15 People who are renters, people living in urban areas, and some racial and ethnic minority groups are more likely to experience housing cost burden.16 Living in unaffordable housing is associated with overall poor health and increased risk of disease, including hypertension and cardiovascular disease.14 Housing subsidies that provide financial assistance to pay rent and public housing assistance programs can help address challenges of housing instability, including housing cost burden.13

Housing cost burden is not a comprehensive measure of housing instability. Measure is calculated from variables in table S2503. Measure calculation: ((S2503_C01_028E + S2503_C01_032E + S2503_C01_036E + S2503_C01_040E)/S2503_C01_001E)*100. Measure calculation is consistent with the ‘Percentage of housing cost-burdened occupied housing units with annual income less than $75,000 (30%+ of income spent on housing costs) estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).

Healthy People 2030 objective: SDOH-04. Reduce the proportion of families that spend more than 30 percent of income on housing.

Adults aged ≥ 25 years

Adults aged ≥ 25 years who did not receive a high school diploma or equivalent

Adults aged ≥ 25 years for the same calendar year

In 2023, 10.2% of adults aged 25 years or older had not received a high school diploma or equivalent.17People from low-income families and some racial and ethnic minority groups are less likely to complete high school.1819 School resources, such as the number of teachers and size of the school, can also affect a persons’ likelihood of completing high school.1920 Not completing high school is linked to a variety of factors that can negatively impact health, including limited employment prospects, low wages, and poverty, and people who do not graduate from high school are at a higher risk of developing chronic conditions (e.g., asthma, type 2 diabetes, heart disease, high blood pressure, stroke) and premature mortality.18192122 Programs that support students transitioning from middle school to high school and allow students to earn college credit while completing high school can help improve graduation rates.1923

High school education might be completed after age at assessment. Measure is from table S0601 (variable S0601_C01_033E). Measure is consistent with the ‘Percentage of persons with no high school diploma (age 25+) estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).

Healthy People 2030 objective: AH 08. Increase the proportion of high school students who graduate in 4 years.

Living below 150% of the poverty level

All people

All people for the same calendar year

In 2023, approximately 65.2 million people in the US lived below 150% of the poverty level.24 Some racial and ethnic minority groups, people living in rural areas, and people with disabilities have a higher risk of living in poverty.25 Poverty often occurs in concentrated geographic areas and can limit access to educational and employment opportunities, which can perpetuate persistent poverty for families.26 People living in poverty often have reduced access to resources, such as health care and healthy foods, which can contribute to a higher risk of developing chronic conditions (e.g., heart disease, stroke, diabetes)2527. Addressing poverty will require multipronged approaches.25 Programs and policies, including those that provide financial and food assistance and health coverage to families with lower incomes, can help to alleviate some of the negative effects of poverty.2527

Measure is calculated from variables in table S1701. Measure calculation: (S1701_C01_040E/S1701_C01_001E)*100. Measure calculation is consistent with the ‘Percentage of persons below 150% poverty estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).

Healthy People 2030 objective: SDOH01. Reduce the proportion of people living in poverty.

All people who identify as any of the following: Hispanic or Latino (any race); Black and African American, non-Hispanic; American Indian and Alaska Native, non-Hispanic; Asian, non-Hispanic; Native Hawaiian and Other Pacific Islander, non-Hispanic; Two or More Races, non-Hispanic; Other Races, non-Hispanic

All people for the same calendar year

In 2023, 42.9% of the U.S. population identified as a racial or ethnic minority, defined as people who identify as Hispanic or Latino (of any race); Black and African American, not Hispanic or Latino; American Indian and Alaska Native, not Hispanic or Latino; Asian, not Hispanic or Latino; Native Hawaiian and Other Pacific Islander, not Hispanic or Latino; other race, not Hispanic or Latino; or two or more races, not Hispanic or Latino.28 Racial discrimination is associated with poor health outcomes such as higher infant mortality rates, higher blood pressure, poorer health status, and worse quality of health care.29 Programs such as CDC’s Racial and Ethnic Approaches to Community Health (REACH) aim to reduce racial and ethnic health disparities and improve health among racial and ethnic minority groups.30

Measure is calculated from variables in tables DP05 and S0601. Measure calculation: ((DP05_0071E + DP05_0078E + DP05_0079E + DP05_0080E + DP05_0081E + DP05_0082E + DP05_0083E)/ S0601_C01_001E)*100. Measure calculation is consistent with the ‘ Percentage minority estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).

All households

All households with a female householder, no spouse/partner present with children of the householder under 18 years, or male householder, no spouse/partner present with children of the householder under 18 years

All households for the same calendar year

Percentage

In 2023, there were an estimated 7.8 million single-parent households in the US.31 Adults in single-parent households are more likely to report poor physical and mental health than other parents and have a higher risk of mortality.3233 Children in single-parent households are more likely to be food insecure, use alcohol, and experience depressive symptoms.3435 Implementing cross-sector strategies, including education, healthcare, social assistance, and child support programs, can help to address the inequities single-parent families may be more likely to experience.3336

Measure is calculated from variables in tables B11012 and DP02. Measure calculation: ((B11012_010E + B11012_015E)/ DP02_0001E)*100. Measure calculation is consistent with the ‘Percentage of single-parent households with children under 18 estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).

None

Population aged ≥ 16 years in the civilian labor force

Unemployed population aged ≥ 16 years in the civilian labor force

Population aged ≥ 16 years in the civilian labor force

Last week or the most recent employment in the past 5 years

As of September 2024, the unemployment rate nationally was 4.1%.37 The Bureau of Labor Statistics (BLS) defines people who are unemployed as those who are jobless but are available to work and have actively looked for work in the past 4 weeks.38 People with a disability and some racial and ethnic minority groups are more likely to experience unemployment.373940 Unemployment is associated with a higher risk of developing chronic conditions (e.g., stroke, heart attacks, heart disease, and arthritis).4142 Several strategies have been implemented to mitigate the negative health impacts of unemployment including temporary financial assistance programs and state unemployment benefits.39

Measure is from table DP03 (variable: DP03_0009PE). Measure is consistent with the ‘Unemployment Rate estimate’ provided in the 2020 CDC/ATSDR Social Vulnerability Index (SVI).

Healthy People 2030 objective: SDOH-02. Increase employment in working-age people.