Health and Health Determinant Metrics for Cities: A Comparison of County and City-Level Data

We evaluated whether using county-level data to characterize public health measures in cities biases the characterization of city populations. We compared 4 public health and sociodemographic measures in 447 US cities (percent of children living in poverty, percent of non-Hispanic Black population, age-adjusted cardiovascular disease mortality, life expectancy at birth) to the same measures calculated for counties that contain those cities. We found substantial and highly variable city–county differences within and across metrics, which suggests that use of county data to proxy city measures could hamper accurate allocation of public health resources and appreciation of the urgency of public health needs in specific locales.