The Behavioral Risk Factor Surveillance System, often referred to as the “BRFSS”, is a federal survey conducted in partnership between the Centers for Disease Control (CDC) and state health departments in U.S. states and territories.
Collected BRFSS data ranges from information on health risk behaviors (like alcohol consumption, exercise, tobacco use, etc.), chronic health conditions (like diabetes, depression, etc.), and use of preventative services (like vaccinations, cancer screenings, etc.).
BRFSS data can provide key insights on Americans’ mental and physical health. Sometimes, though, the amount of data and information can be overwhelming for data users and researchers.
Visualizations, like BRFSS maps and tables, can help users analyze and explore BRFSS data. If you’re looking for BRFSS visualization tools, you’ve found one: State Health Compare, SHADAC’s interactive data tool, lets you easily create clear, understandable, and accessible charts & graphs to start your own analysis of BRFSS data.
Measures Using BRFSS Data on State Health Compare
Currently, there are 11 measures on State Health Compare that utilize BRFSS data:
- Adults Who Forgo Needed Medical Care Due to Cost
- Adults with No Personal Care Doctor
- Adult Cancer Screenings
- Adult Flu Vaccinations
- Adult Excessive Alcohol Consumption
- Adult Smoking
- Adult E-Cigarette Use
- Chronic Disease Prevalence
- Adult Unhealthy Days
- Activities Limited Due to Health Difficulty
- Pre-Existing Conditions
Let’s take a look at a few examples of how you can use State Health Compare to visualize BRFSS data on some of these measures.
Using BRFSS Maps to Explore ‘Adult Unhealthy Days’
The ‘Adult Unhealthy Days’ measure shows users “the average number of days during the past 30 days when an adult's physical health or mental health was not good.” You can use our data visualization tool to explore this information by a number of different breakdowns, including by unhealthy day type (mentally unhealthy, physical unhealthy, or both), by year, by insurance coverage type, and more.
For this example, let’s say you’re interested in adults’ mental health before and during the COVID-19 pandemic. We can use State Health Compares map feature to create a map of adult mentally unhealthy days in 2019 (pre-pandemic) and compare that to 2020 (during pandemic).
Figure 1. Average Number of Adult Mentally Unhealthy Days Map by State, 2019
Accessibility Note: Access the data yourself along with other visualization options on State Health Compare.
Figure 2. Average Number of Adult Mentally Unhealthy Days Map by State, 2020
Accessibility Note: Access the data yourself along with other visualization options on State Health Compare.
By creating these ‘Unhealthy Days’ maps, users can see even at a glance that more states in 2020 fell into the higher number of average unhealthy days categories compared to 2019, showing the potential impact of the pandemic on adults’ mental health.
Looking closer, we can see that 2019 had fewer states in the two highest number of unhealthy days categories, with 8 in the highest category and 10 states in the second highest category. The map using 2020 BRFSS data shows an increase in both of the highest categories: up to 12 states falling in the highest category and up to 19 states in the second highest category.
While further analysis is necessary to make additional conclusions or statements of significance, we can see how simple it is to visualize these general state-level changes using BRFSS maps on State Health Compare.
Using a BRFSS Trend Graph to Explore ‘Adult Smoking’
The CDC calls cigarette smoking, “a major public health concern with over 16 million Americans living with a smoking-related disease.” Smoking tobacco has been linked to increased risks of cancer (particularly lung cancers, but is also linked to about 20% of all cancers according to the American Cancer Society), chronic obstructive pulmonary disease (COPD), heart disease, and more.
Strategies to reduce smoking included policy changes like taxing tobacco products and smokefree air laws, along with cessation education from health care providers and further research connecting smoking to negative health effects.
Let’s look at prevalence of ‘Adult Smoking’ on State Health Compare over time to see the potential impact of those strategies.
Figure 3. Adult Smoking in the United States, 2011 – 2023
Accessibility Note: Access the data yourself along with other visualization options on State Health Compare.
As we can see from the trend line above, adult smoking in the United States has decreased over time. This could be thanks to a combination of targeted public health efforts working to promote smoking cessation, improved education on the risks associated with smoking, policy changes, and more.
Using the breakdowns available on State Health Compare, we can dig into this a bit deeper. Let’s use the breakdown “Age” for adult smoking, continuing with the “Trend” visualization to see how adult smoking has changed over time for different age groups.
Figure 4. Adult Smoking in the United States by Age, 2011 – 2023
Accessibility Note: Access the data yourself along with other visualization options on State Health Compare.
As with the overall United States trend, most age groups saw an overall decrease in ‘Adult Smoking’ between 2011 and 2023, except for the group ‘Age 65+’ which did not see a significant decrease in this time period (8.9% in 2011 to 8.5% in 2023).
Additionally, this trend visualization allows us to see that different age groups reduced adult smoking prevalence at much different rates. For example, we can see that younger age groups like 18-24 and 25-34 had pretty dramatic decreases in smoking between 2011 and 2023, while older age groups like 35-44 and 45-64 saw reductions over time at a more gradual rate.
Using BRFSS Chart to Explore ‘Chronic Disease Prevalence’
For our last example, let’s make a new visualization we haven’t looked at in this blog yet: tables. Let’s look at 2023 BRFSS data on ‘Chronic Disease Prevalence’ broken down by insurance coverage type in the United States and SHADAC’s home state of Minnesota.
Figure 5. Tables of Chronic Disease Prevalence in United States and Minnesota by Insurance Coverage Type, 2023
Accessibility Note: Access the data yourself along with other visualization options on State Health Compare.
This allows you to view and compare a number of different values of chronic disease prevalence both nationally and at the state-level (in this case, in Minnesota). As you can see in the table above, State Health Compare also allows you to view the margin of error for each value (and includes it in the visualization), allowing for significance testing.
For example, at a glance, it appears that those with individual coverage in Minnesota have a higher chronic disease prevalence (26.0%) compared to the U.S. rate (20.4%). Using those and the margin of error values, we calculated the t-statistic and determined, with 95% certainty, that chronic disease prevalence in Minnesota for those with individual health insurance coverage was significantly higher than the U.S. rate for those with individual health insurance coverage in 2023 (see formula and process for significance testing in our blog here).
BRFSS Maps, Trends, and More: Make Your Own on State Health Compare
The BRFSS maps, graphs, and charts on State Health Compare allow you to easily visualize BRFSS data in a number of different ways – over time, by state, in tables, and more. These visualizations can help you explore BRFSS data, ask & answer questions, and dive into breakdowns & disaggregation in an easy and accessible way.
Start your own analysis, download data, and make visualizations to inform your research on State Health Compare for free!
We’d love to see work that uses State Health Compare – follow and tag us on LinkedIn, or contact us here.
If you’d like to learn more about the BRFSS and using BRFSS data, check out our blog: What Is the BRFSS and How Can Researchers Use It? You can also learn more about methods for significance testing on State Health Compare in our brief on the topic.