Academic journal article Social Security Bulletin

Geographic Patterns of Disability in the United States

Academic journal article Social Security Bulletin

Geographic Patterns of Disability in the United States

Article excerpt

Geographic patterns of county prevalence rates of disability benefit receipt are shown for the Social Security Administration's Disability Insurance (DI) and Supplemental Security Income (SSI) programs. Prevalence rates were calculated by dividing each county's December 1990 DI and SSI disability caseloads by the population aged 18-64 for that year in that county. Separate maps were also constructed for men and women recipients. Areas with the highest overall DI prevalence rates included Appalachia, the Southeast Coastal Plains, the Midsouth, northwestern Montana, the coastal counties of Washington, and isolated counties of the Southwest. Areas with the highest SSI prevalence rates included the Mississippi Delta, scattered counties in Oklahoma, the Missouri "Boot Heel," parts of Appalachia, isolated counties in South and North Dakota, the "Four Comers" region of the Southwest, the Sacramento and San Joaquin Valley regions of California, isolated parts of the upper Great Lakes States, northern Maine, and the coastal region of southwestern Alaska. Disability prevalence rates were also calculated for the overall population and by sex for each of the 10 U.S. Department of Health and Human Services administrative regions.

This article provides an overview of the geographic distribution of county prevalence rates of disability benefit receipt under the Social Security Administration's Disability Insurance (DI) and Supplemental Security Income (SSI) programs. The accompanying maps and tables, which contain the supporting evidence for this article, represent counties ranked according to the prevalence of disability benefit receipt for men and women. In addition to the geographic distributions shown, tabular data are presented representing county distributions of the prevalence of disability by Department of Health and Human Services administrative regions.

The purpose of this article is to highlight local areas (counties) with high and low concentrations (prevalence rates) of disability program recipients. The maps and accompanying tables provide an indication of current and potential burdens for Social Security Administration (SSA) planners and program administrators. For example, knowledge of areas with high concentrations of DI and SSI disability beneficiaries could be used by agency administrative personnel and by public health officials to assess needs and availability of appropriate service modalities.

RESEARCH AND POLICY ISSUES

The geographic patterns shown are designed to raise both epidemiologic and policy questions. Why, for example, do certain areas of the United States have a relatively higher prevalence of disability and program participation than other areas? What are some of the contextual or geographic correlates of disability that may explain these patterns? Are there underlying sociodemographic explanations? Are certain employment patterns or mitigating ecological factors, including management practices, associated with certain industries and occupations that suggest higher or lower probabilities of disability? Are "pockets of poverty" and areas with above average unemployment associated with high rates of disability? Are differences in the prevalence of disability explained by local variations in the way SSA administers the DI and SSI programs? Are cyclical factors associated with geographic patterns? Although these questions are not answered here, the presentation of a national geography of disability showing regional and local variations should raise further research and policy questions concerning the Social Security Administration's client populations and the milieus in which they live.

Patterns of area concentration among SSA disability program recipients were first recognized by Schmulowitz and Lynn (1966) and by McCoy and Weems (1989). In these studies reference was made to a "Disability Belt," which includes Appalachia, the Midsouth, and the Mississippi Delta regions. …

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