NU 655 Unit 2 local health data audit example

Local Health Data Audit: Nine Indicators for Children Under Three in a Rural County, and Where Each Number Came From

Student Name

Department of Nursing, Herzing University

NU 655: Foundations of Public Health Nursing

Instructor Name

January 29, 2026

Local Health Data Audit: Nine Indicators for Children Under Three in a Rural County, and Where Each Number Came From

Purpose

Before planning any work for the composite rural county's roughly 1,350 children under three, I gathered the indicators available for this population and recorded, for each, who published it, what period it describes, what geography it covers, what its denominator is, and what limits its use. The values are those found for this composite county; the sources and their characteristics are real types of data a county public health nurse would use.

The Indicators

Each indicator is shown with its source details.

Period Described Versus Year Released

Every figure describes a period that ended before the data were released, sometimes long before. The birth data describe 2023; the census estimates describe five years of survey responses averaged together, from 2019 to 2023, so a change in child poverty after a factory closed in 2022 would appear only partly and gradually. When these figures are presented to the board of health, each will carry its period, not the year of the report it came from, so that no one mistakes 2019 to 2023 poverty for current poverty.

Denominators

The denominators differ in ways that change the meaning of the figures. The vaccination coverage figure uses every child in the registry with a county address, including children whose families moved away but whose records were never updated; those children appear unvaccinated in the county because their later doses were given elsewhere. The true coverage of children actually living in the county is therefore probably somewhat higher than 58%, though how much higher is unknown. The well-child visit measure counts only children continuously enrolled in Medicaid, excluding those who lost and regained coverage, who are likely to be the children with the most disrupted care. The two measures cannot be combined into a single picture of how well children are served.

Small Numbers and Uncertainty

With about 450 births a year, single-year rates for preterm birth and low birth weight would swing widely by chance; the state combines three years for that reason. Infant deaths are too few for any rate to be meaningful, and the state does not publish one; four deaths in five years should prompt individual case review, not rate comparison. The census estimates carry wide margins of error: child poverty of 24% plus or minus 7 points means the true value could plausibly lie anywhere from 17% to 31%, and the county should not be ranked against its neighbors on that basis (U.S. Census Bureau, 2020).

Comparisons and What Can Bear Weight

National vaccination coverage is estimated from a household survey with provider record checks, a different method from the state registry (Hill et al., 2023), so the county's registry figure should be compared with the state's registry figure for the same birth cohort, not with the national survey estimate. Of the nine indicators, the registry coverage figure, used with its denominator problem stated, and the three-year birth outcome figures are strong enough to guide planning. The poverty and insurance estimates describe context but are too uncertain for tracking change. The next step is a registry clean-up of children who have moved, which would make the coverage figure more accurate and is itself an assessment task (Centers for Disease Control and Prevention [CDC], 2012).

References

Centers for Disease Control and Prevention. (2012). Principles of epidemiology in public health practice: An introduction to applied epidemiology and biostatistics (3rd ed.). U.S. Department of Health and Human Services.

Hill, H. A., Yankey, D., Elam-Evans, L. D., Chen, M., & Singleton, J. A. (2023). Vaccination coverage by age 24 months among children born in 2019 and 2020: National Immunization Survey-Child, United States, 2020-2022. MMWR Morbidity and Mortality Weekly Report, 72(44), 1190-1196.

U.S. Census Bureau. (2020). Understanding and using American Community Survey data: What all data users need to know. U.S. Government Publishing Office.