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  • 2024 Technical Appendix

2024 Technical Appendix

This report primarily utilizes 2022 data (the most recent available) from the Behavioral Risk Factor Surveillance System (BRFSS), a self-report survey conducted annually by the Centers for Disease Control and Prevention. We have expanded beyond the data available in BRFSS to include the American Community Survey Public Use Microdata Sample (health insurance coverage) and the CDC: State Unintentional Drug Overdose Reporting System (overdose deaths), which includes 29 states and DC. Child health data is derived from the National Survey of Children’s Health.

In this report, we compared the prevalence rates of several chronic conditions, behavioral and preventive health measures, health insurance coverage, and a number of pediatric health issues among people in Georgia with respective national (US) and regional (Southeast) averages. We used nationally representative data from multiple surveys to assess the prevalence rates across various sociodemographic and socioeconomic domains including sex, age-group, race/ethnicity, income, educational attainment, and urban/rural residence. We assessed how rates varied across these groups within Georgia, and across national and regional levels within each group. Of note, the Southeastern region consists of the following 12 states: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia.

This year’s report covers a total of 25 health topics. Compared to the US national average, prevalence rates of unmet health care needs of children, childhood asthma, exposure to HIV risk, adult obesity, and COPD were found higher among people in Georgia. On the contrary, prevalence rates of overdose deaths, cancer, heavy alcohol drinking, and adverse childhood experiences (ACEs) were lower in Georgia than the respective national averages. Prevalence rates of breastfeeding completion, flu vaccination, and an annual dental visit were lower among people in Georgia as compared to the respective national averages. In general, rates of diabetes, physical exercise, cardiovascular disease, skin cancer, poor mental health, breast cancer screening, and colorectal cancer screening among people in Georgia were comparable to respective national averages.

Compared to the Southeast regional average, Georgia has higher prevalence rates of unmet health care needs of children, childhood asthma, and exposure to HIV risk, and lower prevalence rates of overdose deaths, skin cancer, COPD, cancer, CVD, smoking, adverse childhood experiences (ACEs), childhood obesity, diabetes, and heavy alcohol drinking. Rates of an annual dental visit, breast cancer screening, and child nutrition among people in Georgia were comparable to the respective regional averages.

While the health insurance coverage rate among adults in Georgia was lower than both the national and Southeast regional averages, the coverage rate among children in Georgia was comparable to the national and Southeast regional averages.

We also reported overall state level prevalence rates for each topic. We highlighted the rates for Georgia and the five neighboring states including Alabama, Florida, North Carolina, South Carolina, and Tennessee. Adults in Georgia had the lowest prevalence rates of cancer, skin cancer, cardiovascular disease, diabetes, and drug overdose rates compared to those of their counterparts in neighboring states. In contrast, children in Georgia had the highest prevalence rates of asthma and unmet health care needs compared to children in neighboring states. Health insurance coverage rates among adults and children in Georgia were the lowest and second lowest respectively, among the neighboring states.

There were notable differences in prevalence rates of certain conditions across sociodemographic and socioeconomic groups within Georgia. For example, obesity prevalence among Black adults in Georgia was significantly higher than that of their White counterparts. Compared to adults in Georgia with a college degree, obesity prevalence was significantly higher among adults in Georgia who had educational attainment of high school or less. Differences were also observed across Georgia and the rest of the US within sociodemographic and socioeconomic groups. For example, adults in Georgia without a high school diploma had significantly higher prevalence of cardiovascular disease compared to adults without a high school diploma in the rest of the US.

There were group differences between Georgia and rest of the Southeastern region as well. For example, adults of Hispanic origin in Georgia had a significantly lower rate of adherence to colorectal cancer screening recommendations compared to their counterparts in rest of the Southeastern region. While cigarette smoking rates among females in Georgia were comparable to females in rest of the Southeastern region, smoking rates among males in Georgia were significantly lower than males in the rest of the region. As such, this report provides nuanced insights within and across group differences in prevalence rates of various health conditions of people in Georgia.

We analyzed data from multiple sources including: Behavioral Risk Factor Surveillance System (BRFSS); National Survey of Children’s Health (NSCH); American Community Survey (ACS) 1-Year Data; State Unintentional Drug Overdose Reporting System (SUDORS) Dashboard. We analyzed the 2022 BRFSS to report findings for chronic conditions, noncommunicable diseases, HIV risk, behavioral health, and preventive health. We pooled data from the 2018, 2019, 2020, 2021, and 2022 waves of the NSCH to report findings on pediatric health. The 2022 ACS 1-Year PUMS data was used to report health insurance coverage rates. Rates for the year 2022 were reported from the SUDORS Dashboard. Of note, while the BRFSS, NSCH, and ACS had data for all 50 states and DC, the SUDORS data were available for 30 states including the District of Columbia.

Sociodemographic domains – 2024

Household income: BRFSS reports household income in 11 categories as follows: i) < $10,000; ii) $10,000 to < $15,000; iii) $15,000 to < $20,000; iv) $20,000 to < $25,000; v) $25,000 to < $35,000; vi) $35,000 to < $50,000; vii) $50,000 to < $75,000; viii) $75,000 to < $100,000; ix) $100,000 to < $150,000; x) $150,000 to < $200,000; and xi) $200,000 or more. The percentage of income in relation to the federal poverty level (FPL) was determined as follows: Suppose a respondent’s household income was reported as $20,000 to $24,999. The midpoint of this category, $22,500, was considered as the imputed income level . The family size was determined by adding the number of children and number of adults in the household. For a family size of four (for example, two children and two adults), the federal poverty level threshold in 2022 was $27,750 (except for Alaska and Hawaii). The income to poverty level ratio for this household would be ($22,500/$27,750) × 100% or 81.08%. Of note, midpoint for the top income category, i.e., income ≥ $200,000, was assumed to be $225,000.

Citation for methodology: Hest R. Four Methods for Calculating Income as a Percent of the Federal Poverty Guideline (FPG) in the Behavioral Risk Factor Surveillance System (BRFSS). State Health Access Data Assistance Center. 2019 May.

Prevalence estimation - 2024

Prevalence rates were estimated using complex survey weights of the BRFSS, NSCH, and ACS. The differences across Georgia and the rest of the U.S. or the rest of the Southeastern region were assessed using survey-weight adjusted Wald tests. The level of significance was set at the 5% level. Rates for the overdose deaths are reported directly from the SUDORS Dashboard.

Prevalence trend - 2024

Three-year moving average estimates were used to produce trend graphs for topics for which data were from the BRFSS and ACS. For example, the data point for 2018 in the trend graph is the average of prevalence rates in 2016, 2017, and 2018. Similarly, the data point for 2022 in the trend graph is the average of prevalence rates in 2020, 2021, and 2022. For breast cancer screening, colorectal cancer screening, and oral health for which data are available every other year, the prevalence rate for the missing year was imputed by taking the average of the preceding and succeeding years. For example, the prevalence rate of 2021 was imputed by averaging the prevalence rates of 2020 and 2022.  A similar approach was adopted for HIV risk, for which data were missing for couple of years. Five-year moving average estimates were used for producing trend graphs for child health measures, for which the NSCH data were used.

Distribution by State - 2024

In the distribution chart, along with Georgia, the neighboring five states (Albama, Florida, North Carolina, South Carolina, and Tennessee) were highlighted.

Georgia Ranking Trends - 2024

For each year since 2011 (depending on data availability), states were ranked (in descending order) by prevalence rates for respective conditions. The ranking of Georgia for each year from 2011 to 2022 are presented in the ranking trend chart.

Sample size - 2024

Our sample size for respective topics are as follows:

 

Georgia

Southeast

USA

Data Source

Obesity

8,018

72,987

387,549

BRFSS 2022

Asthma

9,208

81,220

434,071

Cancer

9,183

81,060

433,432

CVD

9,231

81,463

435,457

COPD

9,191

81,144

433,644

Diabetes

9,221

81,338

434,769

Skin Cancer

9,169

80,914

432,710

HIV Risk

7,854

71,676

385,747

Heavy Drinking

7,891

71,900

386,781

Cigarette Smoking

8,213

74,595

400,744

Poor Mental Health

9,014

79,797

426,923

Breast Cancer Screening

3,207

28,206

139,383

Colorectal Cancer Screening

5,990

54,282

279,798

Physical Activity

9,206

81,342

434,742

Flu Shot

7,946

72,475

389,253

Oral Health

9,071

78,928

428,921

Child Nutritious Meal Access

4,532

44,809

202,705

NSCH 2018-2022

Child Obesity

2,488

23,282

104,929

Child Asthma

4,635

45,603

205,870

Child Breastfeeding

1,298

13,734

61,353

Child Unmet Medical Care

4,642

45,888

206,930

Child 3+ ACE Exposure

4,672

46,083

207,735

Insurance Coverage - Adult

87,788

713,722

2,727,672

ACS 2022

Insurance coverage - Child

21,561

160,886

645,706

Drug Overdose Deaths

-

-

-

SUDORS 2022

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