Abstract
BackgroundWell-being is a positively-framed, holistic assessment of health and quality of life that is associated with longevity and better health outcomes. We aimed to identify county attributes that are independently associated with a comprehensive, multi-dimensional assessment of individual well-being.MethodsWe performed a cross-sectional study examining associations between 77 pre-specified county attributes and a multi-dimensional assessment of individual US residents’ well-being, captured by the Gallup-Sharecare Well-Being Index. Our cohort included 338,846 survey participants, randomly sampled from 3,118 US counties or county equivalents.FindingsWe identified twelve county-level factors that were independently associated with individual well-being scores. Together, these twelve factors explained 91% of the variance in individual well-being scores, and they represent four conceptually distinct categories: demographic (% black); social and economic (child poverty, education level [<high school, high school diploma/equivalent, college degree], household income, % divorced); clinical care (% eligible women obtaining mammography, preventable hospital stays per 100,000, number of federally qualified health centers); and physical environment (% commuting by bicycle and by public transit).ConclusionsTwelve factors across social and economic, clinical care, and physical environmental county-level factors explained the majority of variation in resident well-being.
Highlights
Well-being is defined as “a person’s cognitive and affective evaluations of his or her life,” and includes “emotional reactions to events as well as cognitive judgements of satisfaction and fulfillment.”[1]
Twelve factors across social and economic, clinical care, and physical environmental county-level factors explained the majority of variation in resident well-being
Given the positive value of well-being and the recent focus on population health, there is interest in designing communities that support this construct,[14,15,16] but more evidence is needed about local factors that are associated with population wellbeing
Summary
Well-being is defined as “a person’s cognitive and affective evaluations of his or her life,” and includes “emotional reactions to events as well as cognitive judgements of satisfaction and fulfillment.”[1] It is a holistic, positively framed assessment of health and quality of life that captures aspects of an individual’s physical, mental, and social health, beyond the presence or absence of disease, as well as an introspective evaluation of one’s life.[2,3,4,5,6] Higher well-being by definition has inherent positive value, and an individual’s well-being has been independently associated in a dose-response manner with lower risk of cardiovascular events and greater longevity.[7,8,9,10,11,12] Recently, our group extended these findings by reporting a relationship between aggregate well-being and life expectancy at the county level, after accounting for poverty, education and race.[13] Given the positive value of well-being and the recent focus on population health, there is interest in designing communities that support this construct,[14,15,16] but more evidence is needed about local factors that are associated with population wellbeing. We aimed to identify county attributes that are independently associated with a comprehensive, multi-dimensional assessment of individual well-being
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