Faculty Bibliography

The University of Wisconsin Population Health Institute has published County Health Rankings (The Rankings) since 2010. These rankings use population-based data to highlight variation in health and encourage health assessment for all US counties. However, the uncertainty of estimates remains a limitation. We sought to quantify the precision of The Rankings for selected measures. We developed hierarchical models for 5 health outcome measures and applied empirical Bayes methods to obtain county rank estimates for a composite health outcome measure. We compared results using models with and without demographic fixed effects to determine whether covariates improved rank precision. Counties whose rank had wide confidence intervals had smaller populations or ranked in the middle of all counties for health outcomes. Incorporating covariates in the models produced narrower intervals, but rank estimates remained imprecise for many counties. Local health officials, especially in smaller population and mid-performing communities, should consider these limitations when interpreting the results of The Rankings.

BACKGROUND: The prevalence of morbid obesity is increasing throughout Wisconsin and the United States. In 2004, we published a study, "Trends in Bariatric Surgery for Morbid Obesity in Wisconsin." We determined that surgery rates were increasing but felt the demand exceeded the capacity of the surgeons. This is a 6-year follow-up. METHODS: Data was gathered from 3 sources: the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, the Wisconsin Hospital Association, and a survey administered to Wisconsin bariatric surgeons. RESULTS: From 2003-2008, an average of 2.8% of Wisconsin adults were morbidly obese. Although the number of bariatric surgeries performed in Wisconsin remained steady (1311 surgeries in 2003 and 1343 in 2008), the types of procedures shifted from open gastric bypass (73% in 2003) to laparoscopic gastric bypass (80% in 2008). The rate of surgery was 1 for every 100 morbidly obese adults. The majority of surgeons surveyed (70%) report that a lack of insurance benefits is the biggest barrier to performing bariatric surgery. CONCLUSION: The prevalence of morbid obesity continues to increase in Wisconsin compared to our previously published data. Bariatric surgery volumes have remained stable but the type of procedure has changed. Approximately 1% of bariatric surgery candidates have surgery each year.

INTRODUCTION: Environmental factors-such as air and water pollution, lead exposure in homes, or aspects of urban design-influence the health of a community. Monitoring these environmental health influences is a core function of public health, making it necessary to identify critical priorities and effectively target outreach and intervention efforts. This paper reviews the methods used to develop a summary measure of the environmental health of Wisconsin's 72 counties and the city of Milwaukee. METHODS: We collected publicly available data on 9 indicators of environmental health, divided into 3 constructs-air quality, water quality, and the built environment. We looked at how the counties ranked in each construct and then combined the estimates into a summary measure of environmental health. We ranked the summary measure from lowest to highest risk, with higher representing a worse physical environment. RESULTS: In 2007, Wisconsin regions with major metropolitan areas had the worst environmental health risk. In contrast, the 10 counties with the best environmental health were all located in rural areas of the state. CONCLUSION: Publicly available data can be used to compare and contrast environmental health in Wisconsin's communities. Although the measures used to collect these data could be improved, the results can still be used in community health planning and improvement efforts.