Among 500 counties, five in Colorado are among the top 10 healthiest communities in the United States, according to an annual ranking by U.S. News and World Report.

Douglas County placed second on the list, behind only New Mexico’s Los Alamos County. The Denver metro county has been in the top-two every year since the rankings were first compiled in 2018.

Counties were judged on 10 different metrics, ranging from their infrastructure and education to their population health and equity. Each category was given varying weights, and the scores of each category were then compiled to form the overall ranking.

The latest list found that “counties with more educated and higher-earning populations tended to perform better on mental health measures included in the Healthiest Communities analysis,” U.S. News and World Report spokeswoman Sarah Javors said in an email accompanying the release of the rankings.

What’s more, the rankings looked at various COVID-19 metrics and drew some conclusions from them, Javors wrote.

“More than half of the top 500 Healthiest Communities had fewer coronavirus cases per 100,000 people than the national case rate of 9,923 cases per 100,000 people, as of June 4, 2021. Vaccine hesitancy was associated with poorer performances on health metrics, and less than half of the 10 most hesitant counties landed among the top 250 Healthiest Communities, with none in the top 100.”

The top 10 rankings were dominated by Colorado. After Douglas came Broomfield in fourth and Routt in fifth. Pitkin, Summit and San Miguel counties took the last three slots in the top tier. Only Virginia had more than one county in the top 10 and none had more in the top 25.

Pitkin, Summit and San Miguel came one-two-three in a sub-ranking that examined rural and high-performing counties. Custer County came in second on the rural and up-and-coming subgroup. 

Beyond those five, 25 Colorado counties found their way into the top 500. Sixteen of those were in the top 100. 

Though Colorado’s top counties performed well on some of the metrics – like the economy and population health – they consistently struggled in others, like equity. In that category, San Miguel County had the highest score for Colorado, a 66 out of 100. San Miguel posted a high score for food and nutrition, another category where other Colorado communities struggled. 

The equity metric looks at a cross-cutting set of categories, including disparities in poverty, education and air toxins, among others.

One of those sub-categories is labeled the segregation index. According to U.S. News and World reports, that index category is determined by the Theil Index, which according to the U.S. Census Bureau is used to measure economic and inequality. It measures the “‘distance’ the population is away from the ‘ideal’ egalitarian state of everyone having the same outcome.”

According to the rankings, two Colorado counties were in the lowest-performing tier for the segregation index: Douglas and El Paso. Saguache and Costilla both performed best. 

Denver did not fare better than Douglas and El Paso on some equity issues: It performed in the lowest groups for poverty and neighborhood educational attainment disparities.