Health behaviors and the supply of care

In the most deprived tenth of American census tracts, 45.8%45.8% percent of adultsEstimandweighted mean of the tract prevalence in a tenth of tracts (equal numbers of tracts), bootstrap interval over countiesInterval95% CI 45.0% to 46.6%n8,213 tractsWeightsadult population of the tract (PLACES)Populationadults in the most deprived tenth of tracts by ADI national percentile: dental visit in the past yearPeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACES of adults had visited a dentist in the past year, against 70.3%70.3% percent of adultsEstimandweighted mean of the tract prevalence in a tenth of tracts (equal numbers of tracts), bootstrap interval over countiesInterval95% CI 68.5% to 72.1%n8,274 tractsWeightsadult population of the tract (PLACES)Populationadults in the least deprived tenth of tracts by ADI national percentile: dental visit in the past yearPeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACES in the least deprived tenth. The share who had a routine checkup in the past year went the other way, 77.8%77.8% percent of adultsEstimandweighted mean of the tract prevalence in a tenth of tracts (equal numbers of tracts), bootstrap interval over countiesInterval95% CI 77.3% to 78.2%n8,213 tractsWeightsadult population of the tract (PLACES)Populationadults in the most deprived tenth of tracts by ADI national percentile: routine checkup in the past yearPeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACES in the most deprived tenth against 74.2%74.2% percent of adultsEstimandweighted mean of the tract prevalence in a tenth of tracts (equal numbers of tracts), bootstrap interval over countiesInterval95% CI 73.2% to 75.3%n8,274 tractsWeightsadult population of the tract (PLACES)Populationadults in the least deprived tenth of tracts by ADI national percentile: routine checkup in the past yearPeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACES in the least deprived. Both shares are modeled estimatesModeled estimateA figure produced by a statistical model instead of a direct count or measurement, usually for small areas where direct data are thin, borrowing strength from surveys, neighboring areas or other data. Neighboring areas can share errors, so single extremes call for caution. for 2022 from CDC PLACES, and the tenths rank tractsCensus tractA small area drawn by the Census Bureau to stand in for a neighborhood. Boundaries are redrawn after each decennial census. on the Area Deprivation IndexArea Deprivation Index (ADI)A score that ranks neighborhoods by income, education, employment and housing conditions drawn from the American Community Survey. In this book a higher national percentile means a more deprived neighborhood. (ADI).[1, 2]

The dental visit falls with deprivation and the checkup rises

The checkup measures contact with a physician, and the dental visit measures routine dental care. Between the least and the most deprived tenth of tracts, the dental visit rate is 24.4 (95% CI 22.5 to 26.5)24.4 percentage points of adults, lower in the most deprived tenth of tractsEstimanddifference between the weighted mean prevalence of the least deprived and the most deprived tenth of tracts by ADI national percentile, bootstrap interval over counties (draws shared by the two means)Interval95% CI 22.5 to 26.5n8,213 tractsWeightsadult population of the tract (PLACES)Populationadults: dental visit in the past yearPeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACES points lower. The checkup rate is 3.6 (95% CI 2.4 to 4.6)3.6 percentage points of adults, higher in the most deprived tenth of tractsEstimanddifference between the weighted mean prevalence of the least deprived and the most deprived tenth of tracts by ADI national percentile, bootstrap interval over counties (draws shared by the two means)Interval95% CI 2.4 to 4.6n8,213 tractsWeightsadult population of the tract (PLACES)Populationadults: routine checkup in the past yearPeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACES points higher. Figure 1 follows both measures across every percentile of the index. Across the most deprived tenth, the dental line falls fastest and the checkup line rises fastest.

Figure 1

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 same split runs through the report's wider ledger of care. The dental visit falls with deprivation, and so do the screening tests the chapter follows, for cholesterol and for breast and colorectal cancer in the age groups each test covers. The checkup rises, and so does blood pressure medicine among adults with high blood pressure.

How we know

PLACES does not count anyone. It fits a model to answers from the Behavioral Risk Factor Surveillance System (BRFSS) and applies the model to each tract's population. The model uses county poverty and the age, sex, race, ethnicity and education of each tract's residents, all from the census and the American Community Survey.[1] The Area Deprivation Index is built from American Community Survey data as well, so part of every PLACES gradient here is built into the numbers, and the data cannot say how much. The shared inputs do not guarantee a contrast between two measures, such as the checkup and the dental visit. The model can still produce one through the demographic mix of tracts, because the survey answers it is fitted to differ by age, race and education. The comparison covers 82,78182,781 tractsEstimandcount of tractsWeightsnone (full count)Populationcensus tracts with a PLACES estimate and an Area Deprivation Index rankPeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACES tracts that have both a PLACES estimate and an ADI rank. The tract file carries no intervals, so the bands in these charts come from resampling counties and describe that sampling, not the model's own uncertainty. The report gives every estimate with its interval and sample size.

Health measures rise with deprivation, and the checkup rises least

Figure 2 places the checkup beside measures of health, behavior and access that this book selected from PLACES, among them diagnosed diabetes, smoking, depression, food insecurity and the lack of health insurance. Each is more common in the most deprived tenth of tracts than in the least deprived. For the measures other than the checkup, the ratio of the two tenths runs from 1.25 (95% CI 1.21 to 1.30)1.25 ratio of prevalence, most deprived tenth to least deprived tenthEstimandweighted mean prevalence in the most deprived tenth of tracts over that in the least deprived tenth, bootstrap interval over countiesInterval95% CI 1.21 to 1.30n8,213 tractsWeightsadult population of the tract (PLACES)Populationadults: depressionPeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACES for depression to 3.6 (95% CI 3.1 to 4.1)3.6 ratio of prevalence, most deprived tenth to least deprived tenthEstimandweighted mean prevalence in the most deprived tenth of tracts over that in the least deprived tenth, bootstrap interval over countiesInterval95% CI 3.1 to 4.1n8,213 tractsWeightsadult population of the tract (PLACES)Populationadults: all teeth lost, among adults ages 65 and overPeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACES for the loss of all teeth among adults ages 6565 years of ageEstimandage limit of the measure's population (a definition)Weightsnone (definition)Populationadults covered by the PLACES measure of all teeth lostPeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACES and over.

The checkup's ratio is 1.05 (95% CI 1.03 to 1.06)1.05 ratio of prevalence, most deprived tenth to least deprived tenthEstimandweighted mean prevalence in the most deprived tenth of tracts over that in the least deprived tenth, bootstrap interval over countiesInterval95% CI 1.03 to 1.06n8,213 tractsWeightsadult population of the tract (PLACES)Populationadults: routine checkup in the past yearPeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACES, the smallest in the figure, and depression's is the next smallest. Of all 4040 measuresEstimandcount of measures (rule)Weightsnone (rule)PopulationPLACES measures in the tract filePeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACES PLACES measures, 3434 measuresEstimandcount of measures whose 95% interval for the ratio of the most deprived tenth to the least deprived tenth lies above 1n40 measuresWeightsadult population of the tract (PLACES)PopulationPLACES measures in the tract filePeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACES are higher in the most deprived tenth, and the checkup has the smallest ratio of them.

Figure 2

Prevalence is 1.25 to 3.6 times as high in the most deprived tenth of tracts as in the least deprived for 11 measures, and 1.05 times as high for the annual checkup

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 tenthMultiple of the least deprived tenth

Prevalence as a multiple of the least deprived tenth

• 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, Multiple of the least deprived tenth

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

Within states and counties the checkup slope stays near zero

The national rise in the checkup could reflect where deprived tracts are, because checkup rates differ from state to state. Figure 3 draws the slope of each measure on the index in four ways. One is across all tracts. Another gives each state a baseline of its own (state fixed effectsFixed effectsA regression adjustment that gives each group, such as each county, its own baseline. The estimate then rests on differences within groups.), so tracts are compared only within a state, and another does the same for counties. The last works within states and also holds fixed each tract's shares of older, Black and Hispanic residents.

Within a state or a county, the checkup slope is at most 0.270.27 points of prevalence per ten-point step in the ADI national percentileEstimandlargest absolute checkup slope among the specifications that hold the state or county fixedn82,779 tractsWeightsadult population of the tract (PLACES)Populationadults: routine checkup, the three specifications within states or countiesPeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACESNoteA point estimate; the intervals are in the figure. points in size for each ten-point step in the ADI percentile. Within counties it is −0.27 (95% CI −0.35 to −0.19)−0.27 points of prevalence per ten-point step in the ADI national percentileEstimandpopulation-weighted least-squares slope of tract prevalence on the ADI national percentile, times ten; county fixed effects; cluster-robust interval with counties as clustersInterval95% CI −0.35 to −0.19n82,779 tractsWeightsadult population of the tract (PLACES)Populationadults: routine checkup in the past year, within countiesPeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACES, a decline. The dental slope is at least 8.88.8 ratio of absolute slopesEstimandsmallest absolute dental slope over the largest absolute checkup slope among the specifications that hold the state or county fixedn82,779 tractsWeightsadult population of the tract (PLACES)Populationadults: dental visit slope over routine checkup slope, the three specifications within states or countiesPeriodBRFSS 2022 (PLACES 2024 release); ADI 2023SourceCDC PLACESNoteA ratio of two point estimates. times as large in each of those three comparisons, and it is negative in all of them.

Figure 3

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

Within a county, the model gives tracts different values only through the demographic composition of their residents. A slope within counties therefore shows how the model maps composition into prevalence, and not what the residents of those tracts do. The comparison does show a contrast between two measures that share every input. Whenever the state or the county is held fixed, the dental and checkup slopes differ in size by that factor or more.

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, this inverse care lawInverse care lawThe pattern that people who need medical care most tend to receive the least of it. The physician Julian Tudor Hart named it in 1971. predicts fewer providers for each resident in counties with more deprivation, where measures of illness are higher. County Health Rankings counts primary care physicians in 2021, dentists in 2022 and mental health providers in 2023 in each county.[4] The chapter ranks counties on a county ADI, the mean of the county's tract ranks weighted by population, and pools the residents and providers of each tenth of counties. A county with no recorded provider stays in, adding residents and no providers to its tenth.

The most deprived tenth of counties has 2.4 (95% CI 2.1 to 2.6)2.4 ratio of residents per primary care physician, most deprived tenth of counties to least deprived tenthEstimandpooled residents per provider in the most deprived tenth of counties over that in the least deprived tenth, bootstrap interval over statesInterval95% CI 2.1 to 2.6n312 countiesWeightsnone (pooled ratio of counts)Populationresidents of countiesPeriodprimary care physicians in 2021SourceCounty Health Rankings times as many residents per primary care physician as the least deprived tenth, and 2.7 (95% CI 2.3 to 3.1)2.7 ratio of residents per dentist, most deprived tenth of counties to least deprived tenthEstimandpooled residents per provider in the most deprived tenth of counties over that in the least deprived tenth, bootstrap interval over statesInterval95% CI 2.3 to 3.1n312 countiesWeightsnone (pooled ratio of counts)Populationresidents of countiesPerioddentists in 2022SourceCounty Health Rankings times as many per dentist. For mental health providers the ratio is 2.2 (95% CI 1.5 to 3.5)2.2 ratio of residents per mental health provider, most deprived tenth of counties to least deprived tenthEstimandpooled residents per provider in the most deprived tenth of counties over that in the least deprived tenth, bootstrap interval over statesInterval95% CI 1.5 to 3.5n312 countiesWeightsnone (pooled ratio of counts)Populationresidents of countiesPeriodmental health providers in 2023SourceCounty Health Rankings. Their line in Figure 4 rises less evenly, and the most deprived tenth has fewer residents per mental health provider than the ninth, and its interval is wide (550 (95% CI 382 to 882)550 residents per mental health providerEstimandresidents of the counties divided by their providers (a pooled ratio; counties with no provider add residents and no providers), bootstrap interval over statesInterval95% CI 382 to 882n312 countiesWeightsnone (pooled ratio of counts)Populationresidents of counties in the most deprived tenth of counties by county ADIPeriodmental health providers in 2023; residents in the same yearSourceCounty Health Rankings residents per provider).

Figure 4

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

What the gradients describe, and what they do not

These are comparisons between places. Pooled over all tracts, the modeled dental visit rate is lower in the most deprived tenth and the checkup rate is higher. Within states and counties the checkup slope is near zero, and the dental slope is not. The most deprived tenth of counties has more residents for each physician, dentist and mental health provider than the least deprived tenth. A rate among tracts is not any one resident's chance of seeing a dentist. The link between the supply of providers and deprivation could run in either direction or through a third factor such as rurality, and the figures do not separate them. Dental coverage is a separate matter from medical coverage, and the chapter has no measure of it. In Oregon's 2008 lottery for the chance to apply for Medicaid, coverage raised the use of health care, including primary and preventive care, in the first year.[5] The estimate applies to the people and the year that study covers. It changed insurance coverage, which is not the same as changing the number of dentists or mental health providers in a county.

What these data cannot tell you

PLACES values are crude prevalence among adults, not adjusted for age, and CDC advises against using them to rank the overall health of an area or to track local change.[6] Neither care measure says what happened at the visit, whether the care was timely or whether it was affordable. Provider counts place providers where they practice and do not measure capacity, wait times or whether a provider accepts a patient's insurance. County averages hide deserts inside counties and care that crosses county lines. The sources describe different moments, with providers counted from 2021 to 2023, PLACES estimates that describe 2022 and an index built from 2019 to 2023 census data.

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Go deeper

• The report: every estimate with its interval and sample size.
• Tables: every figure of the report as a table.

Same question at another grain:

• Health behaviors and income
  • Chapter 7.2, Health behaviors, person by person Individuals

Reading paths that include this chapter:

• The argument in eight chapters
• Disadvantage as a dose
• The same slope in every place
• Outcomes that do not follow the gradient
• Money and the institutions that follow the map

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

References

1. 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
2. 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
3. Tudor Hart, Julian (1971). The Inverse Care Law. The Lancet 297(7696): 405-412. doi:10.1016/S0140-6736(71)92410-X
4. 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
5. 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
6. 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.}
}