Section 10: Rural

Methods

The Rural Addendum provides data on key sociodemographic characteristics for people with and without disabilities residing in metropolitan (urban), micropolitan, and noncore counties. Data come from the 2017-2021 American Community Survey (ACS) 5-year summary files. To calculate metropolitan (urban), micropolitan, and noncore populations, we first classified county-level data based on 2020 OMB classifications. We then aggregated populations across these metropolitan (urban), micropolitan, and noncore designations to explore geographic differences. For all tables, disability status is based on having responded ‘yes’ to at least one of a series of six disability indicator questions in the ACS. The glossary contains the questions used in the ACS to arrive at the disability estimates. Note that all table estimates exclude persons living in institutions and active duty military personnel. Some questions are asked only of people of certain ages.

Tables

Table 10.1: The prevalence of disability in the United States for the 5-year period from 2017 to 2021 was 12.1% for metropolitan, 16.1% for micropolitan, and 17.8% for noncore counties. Estimated rates were higher in noncore counties for all reported disabilities, including hearing, vision, cognitive, ambulatory, self-care, and independent living disabilities. Table 10.1 Rural Comparison - Prevalence and Population of Civilians Living in the Community with and without Disabilities, by Metropolitan, Micropolitan, and Noncore Status for the United States: 2021

Table 10.2: This table provides demographic information for people with and without disabilities living in metropolitan, micropolitan, and noncore counties. Trends in the data show that as counties become more rural there are higher rates of White and Native American and Alaska Native (AI/AN) populations, and lower rates of Asian, Native Hawaiian and Other Pacific Islander (NH/PI), multi-racial, and Hispanic populations for both people with and without disabilities. Rates of African American/Black people are higher in metropolitan areas and lower in micropolitan and noncore counties. Additional Table Notes: The racial categories included in the census questionnaire reflect a social definition of race recognized in this country and not an attempt to define race biologically, anthropologically, or genetically. In addition, it is recognized that the categories of the race item include racial and national origin or sociocultural groups. People may choose to report more than one race to indicate their racial mixture, such as ‘American Indian’ and ‘White.’ People who identify their origin as Hispanic, Latino, or Spanish may be of any race. The variable for sex is derived from a question that asks individuals to mark either male or female to indicate their biological sex, in cases where this question was invalid the appropriate entry was determined from other information provided for that individual. Table 10.2 Rural Comparison - Demographics of Civilians Living in the Community with and without Disabilities, by Metropolitan, Micropolitan, and Noncore Status for the United States (Populations (#) in Thousands): 2021

Table 10.3: This table compares employment and work experience rates for people with and without disabilities. As counties become more rural, the employment-to-population ratio decreases and the ‘not in the labor force’ rate increases for people with and without disabilities. Notably, 63.4% of the population with disabilities living in noncore counties was not in the labor force, and 61% did not work in the past 12 months. Additional Table Notes: For these data, employment status is derived from a set of questions asking individuals of (1) people who worked at any time during the previous week; (2) people on temporary layoff who were available for work; (3) people who did not work during the previous week but who had jobs or businesses from which they were temporarily absent (excluding layoff); (4) people who did not work during the previous week, but who were looking for work during the last four weeks and were available for work during the previous week; and (5) people not in the labor force. These data represent only individuals between the ages of 18 and 64. For these data, work experience is based on the number of hours an individual reported working per week over the previous 12 months. People 16 years old and over who reported that they usually worked 35 or more hours each week during the weeks they worked are classified as ‘Usually worked full time’; people who reported that they usually worked 1 to 34 hours are classified as ‘Usually worked part time.’ Those who did not report working any regular hours in the previous 12 months are classified ‘did not work’. However, the data in this table represents only individuals between the ages of 18 and 64 years old. Table 10.3 Rural Comparison - Employment of Civilians Living in the Community with and without Disabilities, by Metropolitan, Micropolitan, and Noncore Status for the United States (Populations (#) in Thousands): 2021

Table 10.4: This table shows poverty rates by age and median earnings for people with and without disabilities. Poverty rates for people with and without disability increase for all age groups as counties become more rural. Poverty rates are most pronounced for individuals living in noncore counties, where 32.3% of the population less than 18 years, 29.4% of the population 18-64 years, and 14.3% of the population 65 years and older lives at or below the poverty level. When comparing median earnings, people with disabilities receive significantly less income in metropolitan, micropolitan, and noncore counties when compared to those without disabilities. The median earnings difference between people with and without disabilities, however, is smallest in noncore counties. Additional Table Notes: Poverty status is derived from individual responses to questions on income and family size. If the total income of a person’s family is less than the poverty threshold appropriate for that family size then they are considered ‘below the poverty level’. If a person is not living with anyone related by birth, marriage, or adoption, then the person’s own income is compared with his or her poverty threshold. The total number of people below the poverty level is the sum of people in families and the number of unrelated individuals with incomes in the last 12 months below the poverty threshold. Poverty status was determined for all people except institutionalized people, people in military group quarters, people in college dormitories, and unrelated individuals under 15 years old. These groups were excluded from the numerator and denominator when calculating poverty rates. Data on income is collected for the noninstitutionalized population ages 16 years and older with earnings in the past 12 months. Table 10.4 Rural Comparison - Poverty and Earnings of Civilians Living in the Community with and without Disabilities, by Metropolitan, Micropolitan, and Noncore Status for the United States (Populations (#) in Thousands): 2021

Table 10.5: This table shows health insurance coverage and type for people with and without disabilities. As places become more rural, people with and without disability report lower rates of insurance coverage. For all geography (metropolitan, micropolitan, and noncore), people with disabilities report lower rates of private insurance, and higher rates of public insurance, relative to those without disabilities. Additional Table Notes: Health insurance coverage in the ACS and other Census Bureau surveys define coverage to include plans and programs that provide comprehensive health coverage. Plans that provide insurance for specific conditions or situations such as cancer and long-term care policies are not considered coverage. Likewise, other types of insurance like dental, vision, life, and disability insurance are not considered health insurance coverage. People who had no reported health coverage, or those whose only health coverage was Indian Health Service, were considered uninsured. The health insurance classifications are not mutually exclusive– people may be covered by more than one at the same time. Table 10.5 Rural Comparison - Insurance Coverage of Civilians Living in the Community with and without Disabilities, by Metropolitan, Micropolitan, and Noncore Status for the United States (Populations (#) in Thousands): 2021

Map of Disability in America (2021)

Map Description: A map showing the percent of population with a disability (American Community Survey, 2021)

Reported rates of disability vary across the country with a notable difference between rates in urban and rural counties. In aggregate, we see higher rates in rural counties across a variety of indicators (see Table 10.1). However, rural disability rates are not consistent and clear geographic and regional patterns emerge when exploring these data on a map. The map above shows disability rates at the county level for every county in the United States. Rates are classified by quartile with lower rates shown in lighter purple and higher rates in darker purple. There are clear geographic clusters of both high and low rates of disability throughout the U.S.

There are higher rates of reported disability throughout the rural Southern United States in Appalachia, Southern Missouri and Arkansas, along the border of Mississippi and Alabama and across New Mexico into Southern Colorado. Clusters of high rates of reported disability can also be found in rural areas of Maine, Michigan, Idaho, California and Oregon. Finally, there are high rates of reported disability throughout Puerto Rico.

There is also a noticeable regional pattern where reported rates of disability are lowest. States in the North and Middle Atlantic region as well as across the Midwest, Great Plains and Rocky Mountain West (with the exception of Northern Idaho) all have lower rates of reported disability.

The forces underlying these geographic clusters are complex. Local level social, economic and environmental factors all contribute to people’s experience of disability. Communities and regions experiencing persistent and historical poverty, extractive industry dependence and other forms of social, spatial, and economic marginalization tend to report higher levels of disability. Improving our understanding of how and why rates of disability vary across rural America is valuable for developing effective policies and programs to serve rural people with disabilities.

For more information check out the RTC:Rural’s Disability Counts webpage where you can view and download additional maps for both the nation and states and access disability data by county using our data lookup tool. http://resources.ruralinstitute.umt.edu/resource/disability-counts/