Calculating Grades in Health Sector

The health of Wisconsin is measured using two dimensions: overall health and health disparities. To calculate overall health grades, we use two measures: fair or poor health and mortality. The percentage of those reporting fair or poor health is the prevalence of adults who self-report that
their overall health is fair or poor. Mortality is a rate of death due to all causes per 100,000 population (age-adjusted). To assign overall grades, we calculated state means for all 50 states within the U.S. We then calculated a Z-score of the state means. States with Z-scores greater than 1.5 standard deviations below the mean of all states received an “A” grade; states with Z-scores between 1.5 and 0.5 standard
deviations below the mean received a grade of “B”; states with Z-scores between 0.5 standard deviations below the mean and 0.5 standard deviations above the mean received a “C”; states with Z-scores
between 0.5 and 1.5 above the mean received a “D”; and states with Z-scores greater than 1.5 standard deviations above the mean received an “F.” Within each domain, we calculated state-level subgroup
means. The table below shows each of the subgroups. Whenever possible, we used the most recently available data for the largest number of subgroups available.

Wisconsin Health Grade Measures

Fair or Poor HealthA    MortalityB

Source & Years of Data The Behavioral Risk Factor Surveillance System (2020) CDC WONDER (2015-2019)
Race/Ethnicity • Black
• White
• AIAN
• Asian
• Native Hawaiian and Other Pacific Islanders (NHOPI)
• Multiracial
• Hispanic • Black
• White
• AIAN
• Asian
Education • Less than high school education
• High school diploma or equivalent
• Some post high school education
• Four year college degree or higher • Less than high school education
• High school diploma or equivalent
• Some post high school education
• Four year college degree or higher
Urbanicity • Large Urban MetroB
• Large Suburban MetroB
• Smaller MetroB
• RuralB • Large Urban Metro
• Large Suburban Metro
• Smaller Metro
• Rural
A Crude prevalence unless otherwise noted
B Age-adjusted
After calculating state-level means for each race, education level, and urbanicity, as listed above, we
then calculated population-weighted between group variance (BGV) for each subgroup category. BGV
is an absolute measure of disparity. It measures the sum of the population-weighted difference or distance from each subgroup to the state mean. Eight BGV values were calculated, one for each subgroup
category for each domain, fair or poor health and mortality. To “adjust” the overall grades, we rescaled BGV to have a value between 0 and 1. For each state, we multiplied the state mean mortality rate and
the state mean prevalence of fair or poor health by 1+rescaled BGV. We then recalculated state Z-scores using mean and standard deviation of all 50 states for mortality and fair or poor health. For each domain and each subgroup, the distribution of state Z-scores was graded using previously described cut points.