Exploring Community Health and Risk Factors in Central Indiana

S M Asger Ali, Ally Scott, Jay Colbert, and Sharon Kandris

What You’ll Find in This Report

Data About: 

• Health outcomes such as: 
  • Life Expectancy 
  • Leading Causes of Death 
  • Poor Mental and Physical Health 
• Social and environmental risk factors such as: 
  • Income, Poverty, and Health Insurance 
• Communities with poor health and high-risk 

Geography

This report defines Central Indiana as comprising eleven counties: Boone, Brown, Hamilton, Hancock, Hendricks, Johnson, Marion, Madison, Morgan, Putnam, and Shelby. These counties exhibit varying levels of urbanization. Marion County (Indianapolis), along with Hamilton and Johnson counties, are highly urbanized, featuring substantial suburban and metropolitan development. Boone, Hancock, Hendricks, Madison, and Morgan counties present a mix of urban centers and rural landscapes. In contrast, Brown and Putnam counties are largely rural, with only small, urbanized areas. 

Life Expectancy at Birth

Life expectancy at birth represents the average number of years a person is expected to live and is shaped by factors such as healthcare access, living conditions, and socioeconomic status. Disparities in these factors contribute to significant differences in life span across communities.⁶ A 2015 SAVI article, Gaps in Life Expectancy in the Indianapolis Metro Area,⁷ illustrates this stark contrast: despite being only 28 miles apart, a northeastern suburb of Indianapolis had a life expectancy of 83.7 years, while a community in the urban core just south of Monument Circle had only 69.4 years. Among the 11 counties in Central Indiana, Hamilton County had the highest life expectancy (82.0 years), while Madison County had the lowest (76 years). Although the study was conducted nearly a decade ago, recent data show similar trends across counties. For instance, in 2022, Hamilton County had the highest life expectancy (81.0 years), whereas Madison and Marion counties remained the lowest (73.8 years). In addition, from 2013-2022, every Central Indiana county saw a drop in life expectancy, with Marion (-2.6 years) and Madison (-2.2 years) experiencing the largest declines. This decline may have resulted from the impact of COVID-19, lack of access to healthcare, and pre-existing socioeconomic disparities.⁸ 

Leading Causes of Death

The leading causes of death in Central Indiana’s eleven-counties closely mirror national trends, with heart disease and cancer consistently ranking as the top two. Mortality rates in these counties have remained relatively stable over the years. Over time, mortality rates for chronic lower respiratory disease and stroke (cerebrovascular disease) have shown slight declines, while rates for Alzheimer’s disease have remained relatively steady.    

COVID-19 significantly impacted mortality rates, ranking as the third-highest cause of death from 2020 to 2022. COVID-19 mortality peaked at 114 deaths per 100,000 residents in 2020, declining to 98 in 2021 and 51 in 2022. Despite this temporary shift, heart disease and cancer remained the leading causes of death even during the height of the pandemic, underscoring the persistent public health burden. 

Heart disease and cancer remain the leading causes of death across all eleven counties in Central Indiana, though rates vary by location. Heart disease mortality per 100,000 people is highest in Putnam (190), Morgan (187), and Johnson (184) counties, highlighting a need for targeted cardiovascular health interventions. Cancer mortality follows a similar trend, with the highest rates in Putnam (177), Morgan (173), and Madison (170) counties. Madison and Hancock counties have the highest for chronic lower respiratory disease and stroke, which have been linked to risk factors such as smoking prevalence, environmental exposures, and healthcare access disparities.⁹ Alzheimer’s disease mortality rates vary moderately, with the highest rates in Johnson (38), Hendricks (36), and Shelby (36) counties. 

Physical and Mental Health

Physical and mental health are crucial in shaping quality of life and well-being. Strong physical health enhances energy levels and lowers the risk of severe illnesses, while poor physical health can limit mobility, independence, and overall well-being.¹⁰ Poor mental health affects cognitive functions and the ability to build and maintain meaningful relationships, influencing overall life satisfaction.¹¹ Data from CDC Places indicate that around 18.3% of adults in Shelby County suffer from more than 14 poor mental health days per month, and 15.1% of adults suffer from more than 14 poor physical health days per month. Marion County, the most urbanized county in Central Indiana, also experiences relatively high rates of poor mental (18.1%) and physical (13.7%) health days compared to its surrounding suburbs. Most surrounding counties, like Boone and Hendricks, report better health metrics, with Hamilton County as the lowest rate in Central Indiana.  

Median Household Income

All Central Indiana counties experienced income growth between 2018 and 2022, though at varying rates across the region. Hamilton County remains the highest-income county, increasing 21% from $94,644 to $114,866. As a comparison, the cumulative inflation rate over that time would have been roughly 17.5%, so incomes in general kept up with or surpassed inflation.  Boone County, the second wealthiest, saw a 28% increase, from $80,567 to $103,038, while Hendricks followed with a 22% rise from $78,355 to $95,261. Lower-income counties also experienced steady increases, though their income levels remained significantly lower. Marion and Madison, the region’s lowest-income counties, saw income growth of 27% each, rising from $46,682 to $59,504 in Marion and from $47,436 to $60,060 in Madison. 

Despite the overall increase in median income, significant income disparities persist by race and ethnicity. For example, in Centra Indiana, the Black-white income gap widened by 22% from -$31,131 in 2018 to -$37,968 in 2022, highlighting the persistent income disparity faced by Black households. Similarly, the Hispanic-white income gap shrunk by 17% from -$24,650 in 2018 to -$20,324 in 2022, reflecting faster income growth among Hispanic households compared to Black households. 

A similar pattern emerges in Marion County, where income disparities between white and Black, as well as white and Hispanic residents, persisted from 2018 to 2022. The Black-white income gap grew by 26% from -$23,171 in 2018 to -$29,172 in 2022, underscoring the consistently lower earnings of Black households. Meanwhile, the Hispanic-white income gap decreased by 25% from -$20,326 in 2018 to -$15,276 in 2022, indicating some relative improvement in Hispanic household income compared to white households. 

Poverty

The visuals highlighting poverty rates by race reveal disparities in Central Indiana and Marion County.  The poverty rate decreased nearly 40% among Hispanic residents, the largest decline from 2018 to 2022, resulting in a significant reduction in the gap between Hispanic and white residents. The gap for Black residents and other demographic groups remained nearly the same. 

Counties like Madison and Marion, which have historically struggled with high poverty rates, show persistently high numbers for residents, despite slight declines over time. This suggests that systemic economic challenges, such as job accessibility, wage stagnation, and affordable housing shortages, continue to impact these populations disproportionately. Meanwhile, the poverty rate for white residents has remained relatively stable in both Marion County and the Indianapolis Metropolitan Area, reflecting the racial disparities in economic hardship. The visuals reveal how poverty in Central Indiana is not evenly distributed, with minority communities facing greater financial instability, which may lead to increased migration, limited economic mobility, and long-term impacts on education, housing, and health outcomes. 

Education

There are disparities in educational attainment across racial groups in Central Indiana, which are likely to contribute to broader economic inequality in Central Indiana. Hispanic residents consistently show the highest rates of individuals without a high school diploma, and while there have been slight declines over time, these persistently high numbers suggest systemic barriers to education, such as language barriers, financial hardship, and limited access to educational support systems.  

These educational disparities have direct consequences on poverty rates and economic mobility. A lack of a high school diploma significantly limits job prospects, often leaving these individuals to pursue low-wage jobs with little room for advancement.¹² This is especially concerning in counties where both poverty rates and educational non-attainment rates remain high. The relatively lower and stable rates for white populations across most counties suggest that economic and educational barriers disproportionately affect minority communities. Without increased access to educational resources, job training, and social support systems, these trends likely will continue to reinforce cycles of poverty and limit economic opportunities for marginalized groups in Central Indiana.¹³

Population Living in the Food Desert

Food deserts are geographic areas where residents lack access to affordable, healthy food options, particularly fresh fruits and vegetables, due to the absence of grocery stores within a reasonable distance.¹⁴ Food deserts are mostly in low-income areas where access to cars or private transportation is limited. Research on food deserts has shown that areas with higher incomes can have upwards of three times more grocery stores compared to areas with lower incomes, and neighborhoods that are predominantly white have four times more grocery stores compared to neighborhoods that are predominantly Black. ¹⁵  

In Central Indiana, Shelby County (21%) and Marion County (15%) have the highest percentage of residents living in a food desert. In contrast, nearly all other counties have fewer than 10% of their residents living in a food desert, especially Boone County (less than 1%). Black residents in Central Indiana are more likely to live in a food desert than white or Asian residents, and the same can be seen in Marion County.   

Medicaid Enrollment

The percentage of the population enrolled in Medicaid varies across Central Indiana counties, reflecting differences in healthcare access, socioeconomic status, and insurance coverage. Madison County (26%) and Marion County (25%) have the highest Medicaid enrollment, suggesting a greater proportion of residents with lower incomes or limited access to private insurance.Marion County (9.4%) also has a higher percentage of the population without health insurance, followed by Madison County (7.6%).³ Morgan (16%), Shelby (19.5%), and Johnson (14.2%) counties also report relatively high Medicaid enrollment compared to the regional average. In contrast, Hamilton County (7%) and Boone County (9%) have the lowest enrollment rates, likely due to higher income levels and greater access to employer-sponsored insurance. These disparities highlight the need for targeted healthcare policies to improve coverage and access for vulnerable populations. 

We used census tracts to identify neighborhoods in Central Indiana with the worst health outcomes and elevated risk factors due to overlapping social, economic, and environmental conditions. 

We used a three-step approach to determine these vulnerable areas: 

1. Selection of Indicators – We identified nine key health outcomes, and ten socio-economic and environmental risk factors based on existing literature and available tract-level data.  
2. Data Processing and Scoring – We assigned every census tract a binary value (1 or 0) for each indicator to state whether it is in the bottom 10% for the indicator. For example, tracts in the bottom 10% for a given risk factor, such as poverty rate, received a score of 1, while all others received a score of 0. This process was repeated for all selected health outcomes and risk factors. Then, we calculated two cumulative scores, one for health that adds the scores for the nine health indicators, and one for risk that adds the scores for the ten risk factors. 
3. Mapping and Visualization – We used ArcGIS to map and visualize the distribution of the scores. Health outcome scores range from 0 to 9, and risk scores range from 0 to 10.  To identify the most vulnerable neighborhoods, we selected the census tracts that scored four or higher on both. 

1) Indianapolis (Marion County)  

Location of high-risk/worse outcomes tracts: 

• Near Eastside (Brightwood, Martindale-Brightwood, Brookside, Englewood) 
• Near Westside (Haughville, Hawthorne, Stringtown, Riverside) 
• Northeast (Cumberland, Warren Township, Lawrence) 
• Southside (Fountain Square, Garfield Park, Bean Creek)