While validating county-level health scores across all 3,222 US counties, we found that Kentucky (120 counties) and Pennsylvania (67 counties) had zero disease prevalence data in the current CDC PLACES release. Every other state had valid scores. Nine disease measures were affected: asthma, COPD, coronary heart disease, cancer, kidney disease, diabetes, stroke, depression, and mental health.
We assumed we'd made an ingestion error. We hadn't. The data is genuinely absent from the source. And when we went looking for an explanation, we found one. CDC documented it. But you'd have to know exactly where to look.
Where CDC Acknowledged It
The CDC PLACES Current Release Notes page (updated March 16, 2026) states: “Estimates for Kentucky and Pennsylvania were not available for measures based on the 2023 BRFSS. However, the five measures based on the 2022 BRFSS were carried over for Kentucky and Pennsylvania.”
That's it. One sentence in the release notes. No banner on the PLACES portal. No notice on the dataset landing pages. No email to registered API users. No FAQ entry explaining why two of the highest disease burden states in the country are missing from the nation's primary county-level health data product.
The five measures that survived are colorectal cancer screening, mammography, short sleep duration, dental visits, and complete tooth loss. Everything else for Kentucky and Pennsylvania reads as null.
What Caused It
The root cause is not the 2025 federal data disruptions that have received extensive media coverage. This happened earlier. The 2023 BRFSS Survey Data and Documentation page explains: “During 2023, Kentucky and Pennsylvania were unable to collect enough data to meet the minimum requirements to be included in this public data set.”
BRFSS (the Behavioral Risk Factor Surveillance System) is the survey that feeds PLACES. It's administered by state health departments with CDC coordination. PLACES uses small area estimation models built on BRFSS state-level survey data to produce county and tract estimates. When a state doesn't collect enough BRFSS responses in a given year, the entire downstream estimation pipeline produces nothing for that state. Every county, every census tract, every ZIP code in those two states goes dark for every measure that depends on that survey year.
The Pennsylvania failure has a visible paper trail. On October 25, 2023, nine months into the BRFSS collection year, Penn State's Survey Research Center announced it had been awarded the contract to become Pennsylvania's sole BRFSS data collector. The center described plans to conduct “over 300 telephone interviews a month” while simultaneously hiring project managers and student phone operators. A 300-per-month pace starting in the fourth quarter cannot produce enough responses to meet CDC's full-year minimum distribution requirements. The Pennsylvania Department of Health confirmed the outcome directly: “the 2023 BRFSS survey was not administered due to data collection issues.”
Kentucky's cause is less clear. No public source identifies a specific explanation. The Kentucky Department for Public Health's BRFSS page goes silent after 2021, with the most recent published annual report dating to that year.
This Has Happened Before
The Kentucky and Pennsylvania gap is not an isolated incident. It's part of a recurring pattern of state-level BRFSS failures that has affected PLACES data in multiple release cycles:
| PLACES Release | BRFSS Year | Missing State(s) |
|---|---|---|
| 2021 | 2019 | New Jersey |
| 2022 | 2019/2020 | New Jersey (for 2019-based measures) |
| 2023 | 2020/2021 | Florida |
| 2024 | 2021/2022 | Florida (4 biennial measures) |
| 2025 | 2022/2023 | Kentucky, Pennsylvania |
The 2024 BRFSS release (covering survey year 2024) excludes Tennessee for insufficient collection. If that carries through to PLACES 2026, it would mark the fifth consecutive release cycle with at least one state missing.
The pattern reveals a structural vulnerability in how PLACES works. Because the estimation models require state-level BRFSS data as an anchor, a single state's survey infrastructure failure causes a total data blackout for every sub-state geography in PLACES. There is no partial estimate, no degraded-but-present fallback. The state either met the threshold or it didn't, and 120 counties either have data or they don't.
Why Nobody Noticed
Despite affecting two populous states with significant health-disparity stakes (Appalachian Kentucky and post-industrial Pennsylvania are exactly the geographies PLACES exists to illuminate), public discussion of this gap is virtually nonexistent.
We searched extensively. No Reddit threads in r/datasets, r/publichealth, or r/epidemiology. No Stack Overflow questions. No GitHub issues on the widely used CDCPLACES R package. No data journalism coverage. The February 2026 release blog post for CDCPLACES 1.2.0, written by the package maintainer, discusses other PLACES quirks but does not mention Kentucky or Pennsylvania. KFF's detailed inventory of federal health data disruptions lists BRFSS, YRBS, AtlasPlus, and PEPFAR, but not the PLACES gap specifically. SHADAC's 2025 landscape review of federal health survey releases is similarly silent.
The most likely explanation for the silence is that CDC's communication strategy doesn't match how downstream consumers actually encounter data quality issues. A footnote in release notes reaches the handful of people who read release notes. It doesn't reach the community benefits director pulling a SparkMap report for Shelby County, Kentucky and seeing “No data” for diabetes prevalence. It doesn't reach the health plan analyst whose network adequacy model just silently dropped 187 counties. It doesn't reach the CHNA consultant whose composite health index quietly deflated because null values were treated as zeros.
What We Did About It
Our platform detected the gap automatically during a routine monthly data pipeline refresh. When the ingestion process found zero disease measures for Kentucky and Pennsylvania in the current release, it triggered an automated backfill from the previous PLACES release that contained complete data for both states (the 2022 release, using 2020 BRFSS vintage).
This means our Kentucky and Pennsylvania disease prevalence data is currently from the 2020 BRFSS cycle, while all other states use 2022–2023 BRFSS data. There's a two-to-three year vintage gap between these states and the rest of the country. We label the data vintage on every county profile so users can see exactly how old the estimates are and make informed decisions about how much weight to give them.
The backfill runs automatically each month when our foundation data pipeline refreshes. If CDC restores Kentucky and Pennsylvania disease measures in a future release, the newer data will take precedence without manual intervention.
Recommendations for Other Data Consumers
If your platform, dashboard, or analysis uses CDC PLACES county-level data, we'd recommend checking whether Kentucky and Pennsylvania disease measures are present in your outputs. The current PLACES datasets on data.cdc.gov use dynamic Socrata identifiers that CDC overwrites with each annual release cycle. If you last validated your PLACES integration before the December 2025 release, your pipeline may be silently returning null values for 187 counties without any error.
Specifically, query for any Kentucky FIPS code (21xxx) and check whether measures like CASTHMA, COPD, CHD, DIABETES, and DEPRESSION return values. If they don't, consider supplementing with the previous release's data and clearly labeling the vintage.
Given the historical pattern (at least one state missing in every release cycle since 2021), we'd also recommend adding a state-completeness check to any automated PLACES ingestion pipeline. A simple count of states with non-null disease measures after each refresh would catch this class of issue immediately, regardless of which state is affected next.
The Bigger Picture
The PLACES gap is a specific, verifiable example of a broader challenge in community health data infrastructure. Federal data products are complex pipelines with dependencies at every level: state survey administration feeds federal modeling, which feeds platform aggregation, which feeds local decision-making. A contractor transition in Harrisburg can cause a CHNA team in Louisville to unknowingly work with incomplete data two years later. The current communication infrastructure doesn't propagate data quality signals across those layers effectively.
We think every platform in this space, including ours, has a responsibility to monitor for these gaps, fix them when possible, and communicate clearly when data quality is compromised. That's part of why we're publishing this finding rather than just fixing it internally.
If you're interested in how we handle data freshness and source monitoring more broadly, our methodology documentation covers it in detail.
If you've independently verified the same gap or found additional affected states, we'd welcome hearing from you at info@banana-analytics.com. We'll update this post as we learn more.