City Health Dashboard

Frequent Physical Distress

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

Source:
PLACES Project, Centers for Disease Control.
7%22%13.3
Dashboard-City Average
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 seasons, and therefore may not accurately capture chronic conditions.25

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

Calculation

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 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 2023, 1 year modeled estimate.

References

  1. Slabaugh SL, Shah M, Zack M, et al. Leveraging Health-Related Quality of Life in Population Health Management: The Case for Healthy Days. Popul Health Manag. Feb 2017;20(1):13-22. doi:10.1089/pop.2015.0162

  2. 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. Jan 2011;8(1):A09.

  3. Drum CE, Horner-Johnson W, Krahn GL. Self-rated health and healthy days: examining the "disability paradox". Disabil Health J. Apr 2008;1(2):71-8. doi:10.1016/j.dhjo.2008.01.002

  4. Tara W. Strine, Ph.D., M.P.H., Matthew Zack, M.D., M.P.H., Satvinder Dhingra, M.P.H., Benjamin Druss, M.D., M.P.H., and Eduardo Simoes, M.D., M.P.H. Uninsurance Among Nonelderly Adults With and Without Frequent Mental and Physical Distress in the United States. Psychiatric Services. 2011;62(10):1131-1137.

  5. Sonu S, Post S, Feinglass J. Adverse childhood experiences and the onset of chronic disease in young adulthood. Prev Med. Jun 2019;123:163-170. doi:10.1016/j.ypmed.2019.03.032

  6. Monnat SM, Chandler RF. Long Term Physical Health Consequences of Adverse Childhood Experiences. Sociol Q. Sep 2015;56(4):723-752. doi:10.1111/tsq.12107

  7. Crouch E, Radcliff E, Strompolis M, Srivastav A. Safe, Stable, and Nurtured: Protective Factors against Poor Physical and Mental Health Outcomes Following Exposure to Adverse Childhood Experiences (ACEs). J Child Adolesc Trauma. Jun 2019;12(2):165-173. doi:10.1007/s40653-018-0217-9

  8. Tran TV, Canfield J, Chan K. The association between unemployment status and physical health among veterans and civilians in the United States. Soc Work Health Care. Oct 2016;55(9):720-731. doi:10.1080/00981389.2016.1191582

  9. Harris JR, Huang Y, Hannon PA, Williams B. Low-socioeconomic status workers: their health risks and how to reach them. J Occup Environ Med. Feb 2011;53(2):132-8. doi:10.1097/JOM.0b013e3182045f2c

  10. Sterling MR, Li J, Cho J, Ringel JB, Silver SR. Prevalence and Predictors of Home Health Care Workers' General, Physical, and Mental Health: Findings From the 2014‒2018 Behavioral Risk Factor Surveillance System. Am J Public Health. Dec 2021;111(12):2239-2250. doi:10.2105/ajph.2021.306512

  11. Cicero EC, Reisner SL, Merwin EI, Humphreys JC, Silva SG. The health status of transgender and gender nonbinary adults in the United States. PLoS One. 2020;15(2):e0228765. doi:10.1371/journal.pone.0228765

  12. Potter EC, Patterson CJ. Health-Related Quality of Life Among Lesbian, Gay, and Bisexual Adults: The Burden of Health Disparities in 2016 Behavioral Risk Factor Surveillance System Data. LGBT Health. Oct 2019;6(7):357-369. doi:10.1089/lgbt.2019.0013

  13. Nobles CJ, Valentine SE, Borba CP, Gerber MW, Shtasel DL, Marques L. Black-white disparities in the association between posttraumatic stress disorder and chronic illness. J Psychosom Res. Jun 2016;85:19-25. doi:10.1016/j.jpsychores.2016.03.126

  14. Escalera C, Strassle PD, Quintero SM, et al. Perceived general, mental, and physical health of Latinos in the United States following adoption of immigrant-inclusive state-level driver's license policies: a time-series analysis. BMC Public Health. Aug 24 2022;22(1):1609. doi:10.1186/s12889-022-14022-x

  15. Chowdhury PP, Balluz L, Strine TW. Health-related quality of life among minority populations in the United States, BRFSS 2001-2002. Ethn Dis. Autumn 2008;18(4):483-7.

  16. Brown DR, Carroll DD, Workman LM, Carlson SA, Brown DW. Physical activity and health-related quality of life: US adults with and without limitations. Qual Life Res. Dec 2014;23(10):2673-80. doi:10.1007/s11136-014-0739-z

  17. Brown DW, Brown DR, Heath GW, et al. Associations between physical activity dose and health-related quality of life. Med Sci Sports Exerc. May 2004;36(5):890-6. doi:10.1249/01.mss.0000126778.77049.76

  18. Moon I, Han J. Moderating Effects of Physical Activity on the Relationship between Adverse Childhood Experiences and Health-Related Quality of Life. Int J Environ Res Public Health. Jan 7 2022;19(2)doi:10.3390/ijerph19020668

  19. Strine TW, Chapman DP. Associations of frequent sleep insufficiency with health-related quality of life and health behaviors. Sleep Med. Jan 2005;6(1):23-7. doi:10.1016/j.sleep.2004.06.003

  20. Kemp B, Grumbach JM, Montez JK. U.S. State Policy Contexts and Physical Health among Midlife Adults. Socius. Jan-Dec 2022;8doi:10.1177/23780231221091324

  21. Kim D, Kawachi I. U.S. state-level social capital and health-related quality of life: multilevel evidence of main, mediating, and modifying effects. Ann Epidemiol. Apr 2007;17(4):258-69. doi:10.1016/j.annepidem.2006.10.002

  22. Morgan ER, Hill HD, Mooney SJ, Rivara FP, Rowhani-Rahbar A. State earned income tax credits and general health indicators: A quasi-experimental national study 1993-2016. Health Serv Res. Oct 2020;55 Suppl 2(Suppl 2):863-872. doi:10.1111/1475-6773.13307

  23. Dwyer-Lindgren L, Mackenbach JP, van Lenthe FJ, Mokdad AH. Self-reported general health, physical distress, mental distress, and activity limitation by US county, 1995-2012. Popul Health Metr. Apr 26 2017;15(1):16. doi:10.1186/s12963-017-0133-5

  24. Nelson CC. Using a Social Determinants of Health Summary Measure to Predict General Health Status in the BRFSS. Am J Health Promot. Feb 2022;36(2):301-304. doi:10.1177/08901171211044994

  25. Jia H, Lubetkin EI. Time trends and seasonal patterns of health-related quality of life among U.S. adults. Public Health Rep. Sep-Oct 2009;124(5):692-701. doi:10.1177/003335490912400511

Last updated: March 10, 2026