Prevalence of Disability and Disability Types by Urban–Rural County Classification—U.S., 2016


      In the U.S., disability affects approximately 61.4 million (25.7%) adults, with mobility disability being the most prevalent type, affecting about 1 in 7 U.S. adults. However, little is known about the prevalence of disability and functional disability types by urbanization level.


      Data from the 2016 Behavioral Risk Factor Surveillance System were analyzed. The prevalences of disability, overall and by functional disability type, were estimated among U.S. adults across 6 levels of urban–rural county categories based on the 2013 National Center for Health Statistics Urban–Rural Classification Scheme for Counties. Adjusted prevalence ratios with 95% CIs were estimated by conducting log-linear regression analyses with robust variance estimator while adjusting for study covariates. Data analyses were conducted in 2018.


      The prevalences of having any disability, functional disability type, or multiple disabilities were lowest in large metropolitan centers and fringe metropolitan counties and highest in noncore (rural) counties. After controlling for age, sex, race/ethnicity, education, and federal poverty level, adults living in noncore counties were 9% more likely to report having any disability, 24% more likely to report having 3 or more disabilities, and 7% (cognition) to 35% (hearing) more likely to report specific disability types than the adults living in large metropolitan centers.


      Results of this study suggest that significant disparities in the prevalence of disability exist by level of urbanization, with rural U.S. residents having the highest prevalence of disability. Public health interventions to reduce health disparities could include people with disabilities, particularly in rural counties.
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        • Meit M
        • Knudson A
        • Gilbert T
        • et al.
        The 2014 Update of the Rural-Urban Chartbook.
        Rural Health Reform Policy Research Center, Bethesda, MD2014
      1. Sage R, Ward B, Myers A, Ravesloot C. Transitory and enduring disability among urban and rural people. J Rural Health. In press. Online November 22, 2018.

        • von Reichert C
        • Greiman L
        • Myers A
        University of Montana Rural Institute. The Geography of Disability in America: on Rural-Urban Differences in Impairment Rates.
        University of Montana, Missoula, MT2014
        • Moy E
        • Garcia MC
        • Bastian B
        • et al.
        Leading causes of death in nonmetropolitan and metropolitan areas‒United States, 1999‒2014.
        MMWR Surveill Summ. 2017; 66: 1‒8
        • Seekins T
        • Greiman L.
        University of Montana Rural Institute. Map Facts: Disability in Rural America (Rural Facts).
        University of Montana, Missoula, MT2014
        • Okoro CA
        • Hollis ND
        • Cyrus AC
        • Griffin-Blake S
        Prevalence of disabilities and health care access by disability status and type among adults‒United States, 2016.
        MMWR Morb Mortal Wkly Rep. 2018; 67: 882‒887
        • Anderson WL
        • Armour BS
        • Finkelstein EA
        • Wiener JM
        Estimates of state-level health-care expenditures associated with disability.
        Public Health Rep. 2010; 125: 44‒51
        • Houtenville A
        • Boege S.
        Annual Report on People With Disabilities in America: 2018.
        University of New Hampshire, Institute on Disability/UCED, Durham, NH2019
        • Meyer BD
        • Mok WKC
        Disability, earnings, income and consumption.
        J Public Econ. 2019; 171: 51‒69
        • HHS
        The Surgeon General's Call to Action to Improve the Health and Wellness of Persons With Disabilities.
        HHS, Rockville, MD2005
        • Siconolfi D
        • Shih RA
        • Friedman EM
        • et al.
        Rural-urban disparities in access to home- and community-based services and supports: stakeholder perspectives from 14 states.
        J Am Med Dir Assoc. 2019; 20 (e1): 503‒508
        • Naylor KB
        • Tootoo J
        • Yakusheva O
        • Shipman SA
        • Bynum JPW
        • Davis MA
        Geographic variation in spatial accessibility of U.S. healthcare providers.
        PLoS One. 2019; 14e0215016
        • Matthews KA
        • Croft JB
        • Liu Y
        • et al.
        Health-related behaviors by urban–rural county classification‒United States, 2013.
        MMWR Surveill Summ. 2017; 66: 1‒8
        • CDC, National Center on Birth Defects and Developmental Disabilities, Division of Human Development and Disability
        Disability and health data system (DHDS) data.
        CDC, Atlanta, GA2016
      2. CDC. Behavioral Risk Factor Surveillance System (BRFSS). Accessed December 20, 2018.

        • Mokdad AH
        • Stroup DF
        • Giles WH
        • Behavioral Risk Factor Surveillance Team
        Public health surveillance for behavioral risk factors in a changing environment. Recommendations from the Behavioral Risk Factor Surveillance Team.
        MMWR Recomm Rep. 2003; 52: 1‒12
        • Ingram DD
        • Franco SJ.
        NCHS urban–rural classification scheme for counties.
        Vital Health Stat. 2014; 166: 1-73
        • Li CM
        • Zhao G
        • Hoffman HJ
        • Town M
        • Themann CL
        Hearing disability prevalence and risk factors in two recent national surveys.
        Am J Prev Med. 2018; 55: 326‒335
        • Boring MA
        • Hootman JM
        • Liu Y
        • et al.
        Prevalence of arthritis and arthritis-attributable activity limitation by urban–rural county classification‒United States, 2015.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 527‒532
        • Pharr JR
        • Bungum T.
        Health disparities experienced by people with disabilities in the United States: a Behavioral Risk Factor Surveillance System study.
        Glob J Health Sci. 2012; 4: 99‒108
        • Puri S
        • Herrick JE
        • Collins JP
        • Aldhahi M
        • Baattaiah B
        Physical functioning and risk for sleep disorders in U.S. adults: results from the National Health and Nutrition Examination survey 2005‒2014.
        Public Health. 2017; 152: 123‒128
        • Shandra CL
        • Kruger A
        • Hale L
        Disability and sleep duration: evidence from the American Time Use Survey.
        Disabil Health J. 2014; 7: 325‒334
        • Turk MA.
        Secondary conditions and disability.
        in: Field MJ Jette AM Martin L Workshop on Disability in America: A New Look. The National Academies Press, Washington, DC2006: 185‒193
        • Milaneschi Y
        • Penninx BW.
        Depression in older persons with mobility limitations.
        Curr Pharm Des. 2014; 20: 3114‒3118
        • Zhao G
        • Ford ES
        • Li C
        • Crews JE
        • Mokdad AH
        Disability and its correlates with chronic morbidities among U.S. adults aged 50−<65 years.
        Prev Med. 2009; 48: 117‒121
        • Okoro CA
        • Strine TW
        • Balluz LS
        • et al.
        Serious psychological distress among adults with and without disabilities.
        Int J Public Health. 2009; 54: 52‒60
        • Okoro CA
        • Strine TW
        • Balluz LS
        • Crews JE
        • Mokdad AH
        Prevalence and correlates of depressive symptoms among United States adults with disabilities using assistive technology.
        Prev Med. 2010; 50: 204‒209
        • Covinsky KE
        • Yaffe K
        • Lindquist K
        • Cherkasova E
        • Yelin E
        • Blazer DG
        Depressive symptoms in middle age and the development of later-life functional limitations: the long-term effect of depressive symptoms.
        J Am Geriatr Soc. 2010; 58: 551‒556
        • Cronin-Stubbs D
        • de Leon CF
        • Beckett LA
        • Field TS
        • Glynn RJ
        • Evans DA
        Six-year effect of depressive symptoms on the course of physical disability in community-living older adults.
        Arch Intern Med. 2000; 160: 3074‒3080