Douglas County ranked the eight healthiest county in Kansas for the third year in a row in 2016.

Douglas County ranks as the eighth healthiest county in Kansas for the third year in a row, according to the annual County Health Rankings report by the Robert Wood Johnson Foundation and the University of Wisconsin.

Johnson and Thomas counties took first and second. Riley County, which ranked No. 1 last year, slid to No. 14. Labette and Wyandotte counties ranked lowest, at Nos. 100 and 101.

The rankings compare counties across the United States using local data on more than 30 factors that influence health, including education, housing, jobs, access to healthy food and more.

Counties’ overall rankings depended on two summary scores: health factors, which are behavioral, socioeconomic and environmental factors that impact health; and health outcomes, which measure disease and death, according to an analysis by the Kansas Health Institute. Douglas County ranked No. 11 in health factors and No. 8 in health outcomes.

Several health factors affected Douglas County’s ranking, according to the KHI analysis. The top factors that improved the county’s ranking included adult obesity, ranking at 23 percent compared with the state’s 30 percent; percentage of adults with some college education, at 81.7 percent compared with 68.7 percent; and number of preventable hospital stays, at 31 per 1,000 Medicare enrollees compared with the state’s 55.

However, the county’s ranking was negatively affected by the percentage of adults reporting binge drinking — 21 percent, compared with a state average of 17 percent — and severe housing problems, or percentage of households with overcrowding, high cost or lack of kitchen or plumbing facilities, at 22 percent compared with the state’s 13 percent. Douglas County has the second-highest percentage of severe housing problems in the state, just behind Riley County’s 25 percent, and second-highest binge drinking rate behind Riley County — 21 percent and 22 percent, respectively.

The top five health outcomes positively affecting the county’s ranking include premature death, low birth weight, percentage of adults reporting poor or fair health, and poor physical health days. Douglas County ranked No. 5 in length of life and continues to improve while state and national rates are on the decline.

However, the average number of poor mental health days reported in the past 30 days in Douglas County had a negative impact, at 3.1 compared with the state value of 3.

“The picture of Douglas County that emerges from the 2016 County Health Rankings is one of a well-educated, active community with good recreational opportunities and positive economic indicators, all factors that contribute to its positive ranking compared to the rest of the state,” said Dr. Gianfranco Pezzino, senior fellow and strategy team leader at KHI, via email. “Areas for improvement include encouraging more healthy behaviors (especially in regard to excessive alcohol drinking, the second-highest in the state, and sexually transmitted infections) and reducing income inequality among the county residents (the third-worst in the state).”

Behavioral health factors that affect the county’s ranking have seen some change. Douglas County’s rate of adult obesity has been sloping slightly downward since 2008, and at 23 percent ranks alongside Johnson County for the lowest in the state.

The percentage of adults reporting no leisure-time physical activity is also on the decline, and at 19 percent is third-lowest in state, behind Riley and Johnson counties. Also, the percentage of the population with adequate access to locations for physical activity is 91 percent, or third-highest in the state behind Johnson and Geary counties (99 percent and 95 percent, respectively) and tying with Riley.

However, Douglas County’s ranking in sexually transmitted infections, measured as the newly diagnosed chlamydia cases per 100,000 population, is fifth-worst in the state at 520. The number has trended upward since 2010, and between 2011 and 2012, the number surpassed the national average.

The number of alcohol-impaired driving deaths is improving, and at 26 percent is below the state average of 33 percent. Douglas County also has the lowest number of teen births in the state, at 12 per 1,000 girls ages 15-19.

The county ranks No. 7 statewide in clinical care, with percentages of uninsured, preventable hospital stays, diabetic monitoring and mammography screening all trending positively. The county also falls above the state average ratio of population to mental health care providers — 354:1 compared with 550:1.

Douglas County ranks No. 49 in social and economic factors. Last year the county dropped from No. 35 to No. 45, but the Journal-World reported that the actual measures for that category improved or were unchanged. The drop in ranking indicated that other counties had improved more than Douglas.

This year, however, although the percentage of children living in poverty still falls below the state average of 18 percent, it is on the rise from 15 percent. All but one county in Kansas have child poverty rates that are either increasing or staying the same.

Income inequality measures the ratio of household income at the 80th percentile to income at the 20th percentile; higher ratios indicate greater division between the top and bottom ends of the spectrum, according to the report. Douglas County has an income ratio of 5.0, the third-highest in the state. The state average is 4.4.