Research Snapshot: Exploring Rural Disability Onset

January 10, 2020


Research Snapshot: Exploring Rural Disability Onset

RTC:Rural’s previous research has found that people who live in rural areas begin to experience disability from mobility, cognitive and sensory impairment as much as 10 years before people in urban areas. There are also higher rates of disability in rural areas across all age groups. We have also found that racial and ethnic minorities experience the highest disability rates as well as the greatest urban/rural differences.

While some people are born with a disability, most disability is acquired. This can happen suddenly by injury or slowly by chronic disease. Healing, disease course and medical treatment, underlying causes of disability, often fluctuate. This means people do not always report disability consistently over time.

In order to understand urban/rural differences, RTC:Rural is conducting research to understand how disability evolves in rural and urban areas.

Bryce Ward, RTC:Rural Statistician, explains the project and its goals, and gives a quick progress update. 

What will you be doing for the Exploring Rural Disability Onset project?

Bryce Ward (BW): We know that people in rural areas are more likely to report disability. We also know that disability status fluctuates—some people move into and out of disability. In this project, we are using national datasets that follow lots of people over long periods of time (longitudinal data) to understand both what factors are associated with movement into and out of disability over the life course and what factors/events contribute to higher rates of disability in rural areas.

Why is RTC:Rural doing this research?

BW: Prior RTC projects established both of the motivating facts listed above:  people in rural areas report higher levels of disability at all ages and disability status is not constant for many people– they move in and out of reporting disability. This project leverages three very large national datasets that track the same individuals over decades so that we can do two things: (1) more precisely describe the consistency of people’s disability over time and (2) understand the factors that may contribute to someone moving into disability (or moving out).

Understanding the first issue is important because it fundamentally affects how we think about people with disabilities, how we do research on this population, and how we make policy. Disability is usually treated as binary: someone is disabled or not. However, seeing people move in and out of disability over time (as well as seeing how the likelihood of reporting disability varies with slight differences in question wording across the different studies) helps clarify that disability is not binary. It is a spectrum.  People’s reported disability status changes as their underlying conditions, their environment, and their sensitivity to both change. At any given time, there is a set of people who are currently disabled, but there is also a large group of people at the margins of disability. This affects how we interpret analyses that describe the population or outcomes for people with disabilities by comparing people with disability to people without disability. It should affect how we think about policy related to people with disabilities, e.g., it suggests that there is opportunity to target policy to people at the margins and reduce the share of time (or the propensity) that someone reports disability at a given time.

Understanding the second issue is important because a better understanding of the factors that are associated with the movement into or out of disability– particularly among rural people– is necessary if we want to reduce the share of time people report disability.

What work have you done so far?

BW: We’ve done three main things:

(1) We’ve described how disability moves over time in all three datasets.

(2) We’ve developed a model of disability to guide our empirical work. This model treats disability as continuous and as something that depends on both current and past conditions.

(3) Using one of the datasets, we have begun to explore the factors that contribute to reporting a disability at age 40 or 50 and how these factors vary between rural and urban populations. For instance, we have found that people who report more workplace injuries during their 30s are significantly more likely to report disability at age 40. We also find that people in rural areas are more likely to report workplace injuries. As such, part of the gap in disability rates between rural and urban populations likely reflects the higher propensity for rural people to suffer workplace injuries. Similarly, we have found that other injuries and access to health insurance both also affect disability propensity and both also differ between urban and rural populations.