What's a County?

Ranked places

The County Health Rankings include counties and county equivalents (ranked places). Any entity that has its own Federal Information Processing Standard (FIPS) county code is included in the County Health Rankings. The FIPS county code is a five-digit code in which the first 2 digits designate the state, and the last 3 digits designate county or county equivalent. Certain major cities, such as Baltimore and St. Louis, are considered county equivalents and have their own FIPS county code. Other cities, such as Chicago, do not have a FIPS county code and are not individually ranked. 

County definitions have changed over time due to merging with another county, being dissolved and distributed into other counties, or undergoing a name change. Please read the FAQs to find more information

It is recognized that not all states use a county system, but the County Health Rankings is currently unable to alter the data to reflect the existing governance structures in all states. Communities are encouraged to use the County Health Rankings as a starting point and then dive more deeply into data that are most relevant to their particular governance structure. 

Unranked places

All counties or county equivalents with a FIPS code are eligible to be ranked. In 2022, 60 counties or county equivalents were unable to be ranked due to insufficient data.

Counties were not ranked if any of the following was true: 

  1. The county had a missing value for premature death (this happens when there are less than 20 deaths and the data is suppressed for privacy reasons). 
  2. The county had an unreliable value for premature death and no other measures of morbidity were available. 
  3. The county had an unreliable premature death value, an unreliable low birthweight value, and no other morbidity measures. 

Premature death is considered unreliable when the standard error of the measure is more than 20% of the measure value and the measure value is outside last year's error margin. Both missing and unreliable values for premature death show up as blank in the county snapshot. However, users may visit the analytic files to understand if data is missing or unreliable. Unreliable measures of low birthweight are identified when the standard error of the measure is greater than 20% of the measure value. Low birthweight data is shown on the county snapshot in all cases where it is available.  

Ranking within states

Only counties and county equivalents are ranked within a state. The major goal of the County Health Rankings is to raise awareness about the many factors that influence health and that health varies from place to place. This goal, and issues that arise with data comparability and availability across states, are the reasons that county rankings are only provided within states. 

However, if a user wants to compare counties across the nation, these guidelines describe which measures can be compared across states