Trends and geographical variation in population thriving, struggling and suffering across the USA, 2008-2017: a retrospective repeated cross-sectional study

Carley Riley; Jeph Herrin; Veronica Lam; Brent Hamar; Dan Witters; Diana Liu; Harlan M Krumholz; Brita Roy

doi:10.1136/bmjopen-2020-043375

Trends and geographical variation in population thriving, struggling and suffering across the USA, 2008-2017: a retrospective repeated cross-sectional study

BMJ Open. 2021 Jul 14;11(7):e043375. doi: 10.1136/bmjopen-2020-043375.

Authors

Carley Riley^{1

2

3}, Jeph Herrin^{4

5}, Veronica Lam⁵, Brent Hamar⁶, Dan Witters⁷, Diana Liu⁷, Harlan M Krumholz^{4

8}, Brita Roy^{3

9

10}

Affiliations

¹ Department of Clinical Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA carley.riley@cchmc.org.
² Division of Critical Care, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
³ The Institute for Integrative Health, Baltimore, Maryland, USA.
⁴ Section of Cardiovascular Medicine, Department of Medicine, Yale University, New Haven, Connecticut, USA.
⁵ Flying Buttress Associates, Charlottesville, Virginia, USA.
⁶ Sharecare Inc, Franklin, Tennessee, USA.
⁷ Gallup Organization, Washington, District of Columbia, USA.
⁸ Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, Connecticut, USA.
⁹ Section of General Internal Medicine, Department of Medicine, Yale University, New Haven, Connecticut, USA.
¹⁰ Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, Connecticut, USA.

Abstract

Objectives: Well-being is a holistic, positively framed conception of health, integrating physical, emotional, social, financial, community and spiritual aspects of life. High well-being is an intrinsically worthy goal for individuals, communities and nations. Multiple measures of well-being exist, yet we lack information to identify benchmarks, geographical disparities and targets for intervention to improve population life evaluation in the USA.

Design: Using data from the Gallup National Health and Well-Being Index, we conducted retrospective analyses of a series of cross-sectional samples.

Setting/participants: We summarised select well-being outcomes nationally for each year, and by county (n=599) over two time periods, 2008-2012 and 2013-2017.

Main outcome measures: We report percentages of people thriving, struggling and suffering using the Cantril Self-Anchoring Scale, percentages reporting high or low current life satisfaction, percentages reporting high or low future life optimism, and changes in these percentages over time.

Results: Nationally, the percentage of people that report thriving increased from 48.9% in 2008 to 56.3% in 2017 (p<0.05). The percentage suffering was not significantly different over time, ranging from 4.4% to 3.2%. In 2013-2017, counties with the highest life evaluation had a mean 63.6% thriving and 2.3% suffering while counties with the lowest life evaluation had a mean 49.5% thriving and 6.5% suffering, with counties experiencing up to 10% suffering, threefold the national average. Changes in county-level life evaluation also varied. While counties with the greatest improvements experienced 10%-15% increase in the absolute percentage thriving or 3%-5% decrease in absolute percentage suffering, most counties experienced no change and some experienced declines in life evaluation.

Conclusions: The percentage of the US population thriving increased from 2008 to 2017 while the percentage suffering remained unchanged. Marked geographical variation exists indicating priority areas for intervention.

Keywords: epidemiology; health policy; public health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies*
Geography
Humans
Retrospective Studies
United States

Abstract

Publication types

MeSH terms

Grants and funding