Frequent Physical Distress

Percentage of adults who report ≥14 days of poor physical health in the past 30 days

PLACES Project, Centers for Disease Control.
Dashboard-City Average

Why do we measure frequent physical distress?

Frequent poor physical health can affect all aspects of life. Our measure of frequent physical distress is based on surveyed respondents reporting that they experienced poor physical health for 14 or more days in the past month.1 This self-reported measure can be used to assess how many people have chronic physical health conditions,2,3 and can help identify unmet health and social service needs in a community.4   

Various factors are associated with higher rates of frequent physical distress. There is strong evidence that childhood experiences of trauma are associated with chronic physical pain in adulthood.5-7 Adults in lower-wage jobs, or facing long unemployment, tend to have higher levels of physical distress.8,9 Those without sufficient health insurance, workplace protections, or income may be less able to treat or mitigate the impacts of chronic pain or disability.10 Rates of frequent physical distress are also higher in the LGBT+ population,11,12 and in Black, Latino, American Indian/Alaska Native, and Asian communities.13-15 Discrimination, in combination with structural racial (and gender/sexual orientation) inequalities may contribute to disparities. 

There is evidence that physical activity, sufficient sleep, and stress management strategies are associated with reduced frequency of poor physical health days.16-19 Various supportive state-level policies are also associated with lower population-level rates of frequent physical distress.20-22 Accordingly, there is significant geographic variation in poor physical health across the country.23 Policy makers can focus on increasing access to adequate housing, food, work, and basic quality-of-life measures to help reduce the impact of frequent physical distress.24   

How do we measure frequent physical distress?

Frequent physical distress measures adults, aged 18 or older, who report experiencing poor physical health for 14 days or more in the last month.

Strengths and Limitations

Strengths of Metric

Limitations of Metric

• Frequent physical distress, in combination with frequent mental distress, can be used to better understand health-related quality of life. 

• This metric is easy to capture through standard surveys such as the Behavioral Risk Factor Surveillance System (BRFSS).1


• This metric relies on the person surveyed to define poor health. This makes it difficult to assess reliability and validity, particularly when comparing responses across groups.

• This metric does not specify cause, which makes identifying the best means to intervene difficult.

• People often experience both chronic physical conditions and poor mental health at the same time, making it difficult to separate how one may affect the other.

• The survey is administered at one point in time and may not reflect a person’s average health across a longer period of time, or in different seasons25 and therefore may not accurately capture chronic conditions.

• Survey response rates may differ by area and race/ethnicity, which may underestimate health outcomes among racial/ethnic groups.



Frequent physical distress is calculated by the following formula:

Frequent Physical Distress Calculation

For more information on the calculations, please refer to the City Health Dashboard Technical Document.

Data Source

Estimates for these metrics are from 2018 one year of modeled PLACES Project Data (formerly 500 Cities Project) from the Centers for Disease Control and Prevention. Multi-year data are available for these metrics. For more information, please refer to Using Multi-Year Data: Tips and Cautions

Years of Collection

Data from 2021, 1 year modeled estimate.


  1. Moriarty DG, Zack MM, Kobau R. The Centers for Disease Control and Prevention's Healthy Days Measures - population tracking of perceived physical and mental health over time. Health and quality of life outcomes. 2003;1:37.

  2. Centers for Disease Control Prevention. Measuring healthy days: Population assessment of health-related quality of life. Atlanta, GA: Centers for Disease Control and Prevention. 2000.

  3. Thurston-Hicks A, Paine S, Hollifield M. Rural psychiatry: Functional impairment associated with psychological distress and medical severity in rural primary care patients. Psychiatric Services. 1998;49(7):951-955.

  4. Moriarty DG, Zack MM, Holt JB, Chapman DP, Safran MA. Geographic Patterns of Frequent Mental Distress. American Journal of Preventive Medicine. 2009;36(6):497-505.

  5. Liu Y, Croft JB, Wheaton AG, et al. Association between perceived insufficient sleep, frequent mental distress, obesity and chronic diseases among US adults, 2009 behavioral risk factor surveillance system. BMC Public Health. 2013;13:84.

  6. Strine TW, Balluz L, Chapman DP, Moriarty DG, Owens M, Mokdad AH. Risk behaviors and healthcare coverage among adults by frequent mental distress status, 2001. Am J Prev Med. 2004;26(3):213-216.

  7. Dominick KL, Ahern FM, Gold CH, Heller DA. Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging clinical and experimental research. 2002;14(6):499-508.

  8. Taylor RM, Gibson F, Franck LS. A concept analysis of health-related quality of life in young people with chronic illness. Journal of clinical nursing. 2008;17(14):1823-1833.

  9. Chen HY, Baumgardner DJ, Rice JP. Health-related quality of life among adults with multiple chronic conditions in the United States, Behavioral Risk Factor Surveillance System, 2007. Prev Chronic Dis. 2011;8(1):A09.

  10. Doll HA, Petersen SE, Stewart-Brown SL. Obesity and physical and emotional well-being: associations between body mass index, chronic illness, and the physical and mental components of the SF-36 questionnaire. Obesity research. 2000;8(2):160-170.

Last updated: July 26, 2023