Healthy Georgia - Our State of Public Health

The inaugural issue of the Institute of Public and Preventive Health’s Healthy Georgia: Our State of Public Health report debuted at the Georgia Public Health Association conference in May 2022. The Healthy Georgia report is updated on an annual basis, coinciding with the opening of the Georgia General Assembly’s new session each year.

Purpose

The purpose of the Healthy Georgia report is to provide an evidenced-based overview of public health indicators in Georgia, and how our state compares with others in the southeast region and the United States as a whole. The Healthy Georgia report is intended to inform key public health influencers in Georgia, including our state representatives, government agencies, policymakers, researchers, public health professionals, community leaders, and the public in general. The report will highlight differences, both positive and negative, between Georgia, its neighboring states in the southeast region, and the United States as a whole. It will also highlight disparities within our state based on race/ethnicity, income, and place of residence (rural/urban).

©2024 Augusta University

ISSN 2995-7311

Recommended citations:

2022: Institute of Public and Preventive Health. (2022). Healthy Georgia: Our State of Public Health (May 2022). Augusta University.

2023: Institute of Public and Preventive Health. (2023). Healthy Georgia: Our State of Public Health (Update, January 2023). Augusta University.

2024: Institute of Public and Preventive Health. (2024). Healthy Georgia: Our State of Public Health (Update, January 2024). Augusta University.

Behavioral Risk Factor Surveillance System (BRFSS) The BRFSS is a telephone survey that collects data across all 50 states as well as the District of Columbia and three U.S. territories. The data collection has been sponsored by the CDC National Center for Chronic Disease Prevention and Health Promotion; other CDC centers; and federal agencies, such as the Health Resources and Services Administration, Administration on Aging, Department of Veterans Affairs, and Substance Abuse and Mental Health Services Administration.

National Survey of Children’s Health (NSCH) The NSCH is administered in various formats across the nation and each of the 50 states plus the District of Columbia. The data collection is funded and directed by the Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCHB).

PUMS

U.S. Centers for Disease Control and Prevention (CDC): COVID Data Tracker

U.S. Centers for Disease Control and Prevention (CDC): State Unintentional Drug Overdose Reporting System (SUDORS) Includes 29 states and the District of Columbia.

Race/ethnicity: White, Black, and Asian refer to self-identified non-Hispanic White, non-Hispanic Black, and non-Hispanic Asian respondents respectively. The “other” category includes American Indian, Native Hawaiian/ Pacific Islander, multiracial, and other.

Residence: The BRFSS reports whether the respondent resides in an urban or a rural county. Urban refers to large central-, large fringe-, medium-, or small- metropolitan, and micropolitan counties. Rural refers to noncore counties. Rural/urban determination was not available in the NSCH and ACS 1-Year data.

In this report, we compared the prevalence rates of several chronic conditions, and behavioral and preventive health issues among Georgians with respective national (U.S.) and regional (Southeast) averages. We used nationally representative data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) and the last five waves (2016 to 2020) of the National Survey of Children’s Health (NSCH) to assess the prevalence rates across the following domains: sex, race/ethnicity, income, and residence (urban/rural). We further reported the prevalence rates by age group and educational attainment.

Among chronic conditions, the prevalence of high cholesterol among Georgians is comparable to the national average, but lower than the regional average. Prevalence rates of hypertension and obesity, however, are significantly higher among Georgian adults than the national average, though lower than (for hypertension) and comparable to (for obesity) the regional average. Other than asthma, the prevalence rates of noncommunicable diseases among Georgians are lower than respective regional averages. Georgians, however, have higher cardiovascular diseases (CVD) prevalence compared to the national average.

Among behavioral health issues, prevalence of heavy drinking among Georgians is lower than the national and regional average. Prevalence of current smoking, though lower than the regional average, is higher than the national average. Georgians also report lower prevalence of depressive disorder than the national and regional averages. Among preventive behaviors, the influenza vaccination (flu shot) rate in Georgia is significantly lower than both national and regional averages. Among child health issues, Georgia children have a higher prevalence of asthma than the national and regional averages. Obesity among Georgia children, though lower than the regional average, is significantly higher than the national average.

Adults in Georgia who self-identified as Asian have a significantly lower prevalence of high cholesterol, hypertension, and obesity than their counterparts at both the national and regional levels. Conversely, prevalence rates of asthma, COPD, and current smoking for adults in Georgia who self-identified as Asian are significantly higher than their counterparts. Prevalence rates of noncommunicable diseases among adults in Georgia who self-identify as Hispanic are lower than adults who are not Hispanic at both the national and regional levels. Prevalence of childhood obesity among children identified as Hispanic, in contrast, is significantly higher than their out-of-state counterparts.

Sources of Data - 2022

Data for chronic conditions, non-communicable diseases, behavioral health, communicable diseases, and preventive health, were obtained from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) for all topics except for hypertension and high cholesterol. Data for these two conditions are collected every other year, thus data from the 2019 BRFSS were used. Data for child health was obtained from the National Survey of Children’s Health (NSCH). Data was pooled from the 2016, 2017, 2018, 2019, and 2020 waves of the NSCH for analysis.

Sample size - 2022

Our sample size for respective topics are as follows:

Household income - 2022

BRFSS reports household income in eight categories. The percentage of income in relation to the federal poverty level (FPL) is determined as follows: Suppose a respondent’s household income is 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 2020 was $26,200 (except for Alaska and Hawaii). The income to poverty level ratio for this household would be ($22,500/$26,200) × 100% or 85.88%.

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 - 2022

Prevalence rates were estimated using complex survey weights of the BRFSS and NSCH. The differences across Georgia and rest of U.S. or rest of the Southeast region were assessed using survey-weight adjusted Wald tests. Level of significance was set at the 10% level. The Southeast region consists of the following 12 states: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia.

Prevalence trend - 2022

Three-year moving average estimates were used to produce trend graphs for their respective conditions. For example, the data point for 2016 in the trend graph is the average of prevalence rates in 2014, 2015, and 2016. Similarly, the data point for 2020 in the trend graph is the average of prevalence rates in 2018, 2019, and 2020. For hypertension and high cholesterol, 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 2018 was imputed by averaging the prevalence rates of 2017 and 2019.

Limitations in 2022

The conditions were self-reported in the BRFSS and NSCH. The 2020 waves of the surveys were conducted amid the COVID-19 pandemic, and hence, the estimates could differ from those in pre-pandemic years.

In this report, we compared the prevalence rates of several chronic conditions, and behavioral and preventive health measures among Georgians with respective national (U.S.) and regional (Southeast) averages. We used nationally representative data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS) and the last five waves (2017 to 2021) of the National Survey of Children’s Health (NSCH) to assess the prevalence rates across the following domains: sex, race/ethnicity, income, and residence (urban/rural). We further reported the prevalence rates by age group and educational attainment. We also assessed health insurance coverage using data from the 2021 American Community Survey (ACS) 1-Year Public Use Microdata Sample (PUMS), and COVID-19 vaccination coverage using data from the U.S. Centers for Disease Control and Prevention (CDC) COVID Data Tracker website.

Across chronic conditions, the prevalence of high cholesterol among Georgians is comparable to the national and regional averages. Prevalence of hypertension, however, is significantly higher among Georgian adults than the national average comparable to the regional average. Prevalence of obesity, in contrast, is comparable to the national average, but significantly lower than the regional average. Among noncommunicable diseases, Georgia has a significantly lower prevalence of cancer compared to the national and regional averages. Prevalence of CVD in Georgia, while higher than the national average, is significantly lower than the regional average.

Among behavioral health measures, prevalence of smoking among Georgian adults, though lower than the regional average, is higher than the national average. Georgians report lower prevalence of depressive disorders than the national and regional averages. Among preventive behaviors, the influenza vaccination (flu shot) rate in Georgia is significantly lower than both national and regional averages.

Across child health measures, children in Georgia have a higher prevalence of asthma than the national and regional averages. Breastfeeding among children in Georgia, though comparable to the regional average, is significantly lower than the national average. Prevalence of unmet medical care is significantly higher among children in Georgia compared to the national and regional averages.

Compared to both national and regional averages, health insurance coverage among Georgian adults is significantly lower. COVID-19 vaccination rates among Georgians are also lower than the rest of the U.S.

Sources of data - 2023

We analyzed the 2021 Behavioral Risk Factor Surveillance System (BRFSS) to report findings for chronic conditions, noncommunicable diseases, behavioral health, and preventive health. Of note, the BRFSS 2021 provides data on all U.S. states and the District of Columbia, except Florida. We analyzed data from the National Survey of Children’s Health (NSCH) to report findings on pediatric health. We pooled data from the 2017, 2018, 2019, 2020, and 2021 waves of the NSCH. For health insurance coverage, we abstracted data from the 2021 American Community Survey (ACS) 1-Year Public Use Microdata Sample (PUMS) data. Lastly, we obtained COVID-19 vaccination data from the COVID Data Tracker website of the U.S. Centers for Disease Control and Prevention (CDC).

Sample size

Our sample size for respective topics are as follows:

Household income – 2023

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 level¹. 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 2021 was $26,500 (except for Alaska and Hawaii). The income to poverty level ratio for this household would be ($22,500/$26,500) × 100% or 84.91%. 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 - 2023

Prevalence rates were estimated using complex survey weights of the BRFSS, NSCH, and ACS. The differences across Georgia and the rest of the United States or the rest of the southeastern region were assessed using survey-weight adjusted Wald tests. Level of significance was set at the 10% level. 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.

Prevalence trend - 2023

Three-year moving average estimates were used to produce trend graph for their respective conditions. For example, the data point for 2017 in the trend graph is the average of prevalence rates in 2015, 2016, and 2017. Similarly, the data point for 2021 in the trend graph is the average of prevalence rates in 2019, 2020, and 2021. For hypertension and high cholesterol, 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 2018 was imputed by averaging the prevalence rates of 2017 and 2019. Prevalence trends were reported for topics for which data were obtained from the BRFSS and the ACS surveys. Prevalence trends were not presented for child health measures, for which data were pooled from 2017 to 2021 waves to acquire state level representation.

Limitations - 2023

The conditions were self-reported in the BRFSS and NSCH. The U.S. and Southeastern region averages for the topics using BRFSS data excluded observations from Florida due to data unavailability. The 2021 wave of the surveys were conducted amid the COVID-19 pandemic, and hence, the estimates could differ from that in a pre-pandemic year.

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.

Sample size

Our sample size for topics featured in the report are as follows:

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.

Adults

Children