Methodology and Data

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This research study was designed to examine the following questions:

  1. Is there a link between geographic location within New Jersey and health status or health disparities?
  2. How prevalent are chronic diseases in New Jersey and do they vary by location?
  3. Is there a link between social determinants – such as income, education, housing and transportation – and health status and life expectancy?
  4. What level of influence do social determinants have on maternal and infant health status?
  5. Does premature death (prior to age 65) vary by geographic location?


The measurement of health status is central to the evaluation of overall population health. There can be variation in health outcomes within a given population for a variety of reasons, such as socio-economic differences. The team from CHART gathered 20 metrics to develop a scorecard of health status and health vulnerability by zip code. Identifying both individual and community dynamics that serve to increase or decrease health risk by developing an aggregated score of multiple measures allows for the creation of a single index or score for each community in the state.


Hospital inpatient and emergency department claims data alone cannot illuminate differences in health status from one community to another. For the purposes of this study, the term health status refers to the differences between one community and another in terms of the overall incidence of disease, mortality, and the presence of socio-economic factors that contribute to poor population health and increased vulnerability. Health vulnerability also relates to physical, psychological, social and environmental conditions that can contribute to lack of access to care and utilization rates.

CHART’s selection of these metrics incorporates consideration of several factors. Metrics were selected based on their measurability and relevance across all communities. CHART chose metrics from publicly available data sets and developed a weighted health status/vulnerability score for each community in the state.


The results revealed tremendous disparities across New Jersey communities in utilization, access and social measures – results that correlate with health vulnerability.