Economic conditions explain most of the variation in disability rates across American communities

The rate of disability varies tremendously across states and communities in the U.S. An ecological study of the relationships between community rates of disability and community economic and demographic characteristics was undertaken using the American Community Survey (ACS). The ACS measures disability in physical activities, cognition, activities of daily living, and vision and hearing. Disability in work is not used in the analysis. For the period 2005-2007, the sample comprised 6.7 million adults living in 2,069 Census-defined areas having populations of approximately 100,000 persons and consisting of counties, groups of counties, cities, and city neighborhoods. Rates of any disability and in activities of daily living (IADL/ADL) were analyzed separately for working age and older adults. For the working age population, the range in the rate of any disability varied 10-fold: three areas in KY had the highest rates (32.1-34.3%) while the well-to-do area of west northwest Washington, DC had the lowest rate at 3.0 percent. Multivariate regression analysis demonstrates that economic characteristics (rates of employment, poverty, college attendance; R-sq=0.70) explain more of the variation than demographic characteristics (age, gender, race and Hispanic ethnicity; R-sq=0.04). Together, they explain almost 80 percent of the variation. Similar results are obtained for IADL/ADL. Somewhat more variable results are obtained for disability in older populations with about two-thirds of the variance explained. Variation in disability rates across American communities is primarily a function of economic and secondly, demographic conditions of communities.