“Counties like it” are metro-area counties with a similar population and a median household income near Middlesex County's ($123,288). Ahead or behind means more than 15% better or worse than the typical one.
Ahead of similar counties on 6 measures:
Behind similar counties on 1 measure:
About the same on 4: drug overdose deaths per 100,000, life expectancy, households with severe housing problems, households with broadband internet.
| Measure | Middlesex County | Typical similar county |
|---|---|---|
| Population change, 2020–2024 | 2.5% 1,627,578 → 1,668,956 | 1.9% |
| School spending per student (day-to-day costs) | $24,815 | $18,792 |
Sources: U.S. Census Bureau Vintage 2024 population estimates; Census Annual Survey of School System Finances (school year 2023), current spending divided by enrollment across the districts based in the county.
“Counties like it” means other counties in a metro area with a similar number of people and a similar median household income (about $123,288 here). Comparing with them, instead of the whole country, shows what similar places have managed. Middlesex County is furthest behind on bridges rated poor.
| Measure | Middlesex County | Typical similar county | Doing best among similar counties |
|---|---|---|---|
| Drug overdose deaths per 100,000 about the same | 24.3 | 23.1 | Collin County, TX 10.1 Fort Bend County, TX 10.3 Denton County, TX 10.3 |
| Life expectancy about the same | 81.5 years | 80.4 years | Fairfax County, VA 84.5 years San Mateo County, CA 84.1 years Montgomery County, MD 83.2 years |
| Adults under 65 without health insurance ahead of similar counties | 2.4% | 6.6% | Norfolk County, MA 2.4% District of Columbia, DC 3.1% Worcester County, MA 3.2% |
| Residents per primary care doctor ahead of similar counties | 803 | 1,079 | San Francisco County, CA 610 New York County, NY 731 Nassau County, NY 734 |
| Residents per mental health provider ahead of similar counties | 139 | 243 | San Francisco County, CA 90 New York County, NY 90 Denver County, CO 126 |
| Children in poverty ahead of similar counties | 7.6% | 10.1% | Johnson County, KS 4.9% Denton County, TX 5.9% Nassau County, NY 6.3% |
| Food insecurity ahead of similar counties | 8.3% | 10.1% | Nassau County, NY 7.0% Norfolk County, MA 7.6% Chester County, PA 8.1% |
| Households with severe housing problems about the same | 16.0% | 16.6% | Johnson County, KS 10.1% Anne Arundel County, MD 12.1% Chester County, PA 12.1% |
| Unemployment ahead of similar counties | 2.9% | 3.4% | Anne Arundel County, MD 1.8% Montgomery County, MD 1.9% Prince George's County, MD 2.2% |
| Households with broadband internet about the same | 94.2% | 93.8% | Fairfax County, VA 96.3% Collin County, TX 96.1% Cobb County, GA 95.9% |
| Bridges rated poor behind similar counties | 11.1% | 4.3% | Cobb County, GA 0.0% Travis County, TX 0.1% Collin County, TX 0.1% |
“Behind” or “ahead” means more than 15% worse or better than the typical (median) similar county; small differences can be noise. Sources: County Health Rankings 2025 (health, money and internet), Vera Institute (jail, latest year from 2015 on), FHWA National Bridge Inventory 2025, HUD (metro areas), Census 2024 population. What has worked elsewhere on each of these.
“Highest” and “lowest” are just order, not grades: a high rank for poverty or hazard losses means more of it. Each figure's source is in its section below.
Related: By the numbers · The money trail · Audits · What has worked. Spot an error? Report it.