Suburban counties again head the rankings of Georgia’s healthiest counties.

For the fourth straight year, Forsyth County is the healthiest in Georgia, according to the 2016 County Health Rankings, released Wednesday by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Forsyth was followed by Oconee, Fayette, Harris and Gwinnett. Rounding out the Top 10 were Cherokee, Cobb, Columbia, Paulding and Coweta.

Forsyth and six others are in suburban Atlanta. Oconee is near Athens, Columbia near Augusta, and Harris is just north of Columbus, and has high per-capita income.

At the bottom of the Georgia list is Quitman County. Seven of the bottom 10 counties, like Quitman, lie in the southwest corner of the state.

Here’s a list of the Georgia counties’ rankings.

The data feature more than 30 factors that influence health, including poverty, health insurance, education, housing, jobs, smoking, and access to physicians and to healthy food.

Nationally, the report found that rural counties not only have higher rates of premature death, but also nearly 1 in 5 rural counties saw increases in premature death rates over the past decade, while most urban counties have experienced consistent improvement.

Rural counties nationally have higher rates of smoking, obesity, child poverty and births to teenage mothers, and they also have higher numbers of uninsured adults than their urban counterparts, according to the report’s authors.

For example, in Georgia, Quitman has high percentages of smoking, obesity, physical inactivity, teen births, uninsured residents and children in poverty.

Meanwhile, Forsyth County, in the affluent northern Atlanta suburbs, has low levels of each of those factors.

The report found large urban counties generally have lower smoking and obesity rates, fewer deaths from injuries, and more residents who have attended some college. And large suburban counties have the lowest rates of childhood poverty and teen births.

“Most striking in these data is how different the counties around metro Atlanta are from the rest of the state,’’ said Marsha Davis, an associate dean at the University of Georgia’s College of Public Health.

The people who live in urban/suburban counties in metro Atlanta, she said, have better health outcomes and behavior, have fewer children living in poverty, are more likely to have medical insurance, are more educated and employed, and live in environments with access to healthy food and locations to be physically active.

Rural Georgia is seeing a rise in premature death rates while urban/suburban county rates are improving, Davis noted.

“Public health and policy makers need to be focused on the needs and assets of rural Georgians to decrease these urban-rural disparities, she said. “We succeed as a state only if everyone, no matter where they live in Georgia, have the opportunity to be their healthiest.’’

Dr. Richard Rothenberg, Regents professor of epidemiology and biostatistics at Georgia State University, said that Georgia is close to national averages on the majority of measures cited, despite the extent of rural poverty in the state.

“In several areas, Georgia is doing better than the country as a whole,” Rothenberg said. “It may be a surprise to some that the driving deaths associated with alcohol are actually less common in Georgia than in the nation, on average.  On the other hand, the occurrence of sexually transmitted disease, represented in these tables by chlamydia, is twice the national rate.” And not included in these data is the prevalence of HIV in the state, he said.

Scott Weaver, assistant professor of epidemiology and biostatistics at the School of Public Health at Georgia State, added that it would be a mistake for policy makers and others studying these rankings to conclude that an urban advantage in health is experienced by all urban-residing Georgians.

“County-level data and rankings often obscure stark health inequalities that exist within many urban areas, and this is particularly true within Fulton County, where life expectancies of people in certain ZIP codes is southwest Atlanta is more than 10 years less than life expectancy of those living in Midtown,” Weaver said. “There are many urban [residents] with health outcomes that are just as poor, if not worse than, those in the poorly ranked rural Georgia counties.”