The Regional Geography of Disability in the United States

Researchers from Nationhood Lab, the University of Illinois-Chicago, and the HealthPartners Institute found significant differences in the prevalence of disabilities across the American Nations in a new paper published in the Journal of Cardiopulmonary Rehabilitation and Prevention

Disability prevalence (2021); Credit: John Liberty/Motivf for Nationhood Lab

By Colin Woodard

Researchers have found substantial regional differences in the prevalence and distribution patterns of disabilities in the U.S., with the Deep South, Greater Appalachia, and the First Nation section of Alaska experiencing the worst rates.

The findings, published in the Journal of Cardiopulmonary Rehabilitation and Prevention, used my American Nations model and county-level data for 2021 from the U.S. Centers for Disease Control to examine rates of self-reported disabilities, including those related to hearing, vision, cognition, mobility, self-care and independent living.

The data revealed significant differences in age-adjusted disability rates across U.S. regional cultures, with the rate in the Deep South (32.1% of the population) about sixth higher than in New Netherland (23.4%) or Left Coast (25.4%) In the First Nation section of Alaska – populated predominantly by members of Alaska Native communities – an alarming 39.2% of the adult population is disabled.

The researchers –Ross Arena of the University of Illinois – Chicago, HealthPartners Institute president Nicolaas Pronk, and myself (director of Salve Regina University’s Nationhood Lab) – found county-level geographic patterns matched those previously documented for Covid-19 vaccinations and deaths, deadly gun violence, life expectancy, diabetes, obesity and physical inactivity.

“There is an apparent disability belt expanding across the southern regions that encompass several of the American Nations, including Greater Appalachia, Deep South, El Norte, and New France,” wrote lead author Arena, head of the physical therapy department at UIC. “Epicenters of particularly high prevalence within the belt exist within the Deep South and Greater Appalachia regions.”

The overlap between the prevalence of disability and physical inactivity (or PI) was particularly striking (an 0.87 correlation.) “We were not surprised to find a significant county-level relationship between PI and disability prevalence, but the strength of this relationship was unexpected,” Arena wrote.

“Our findings indicate unique cultural factors, according to the American Nations model, play a role in both PI and disability preference,” he added. “A better understanding of unique driving forces for health challenges at a regional/local level is needed.”

This year Arena, and Pronk and myself have been engaged in an ongoing research collaboration with other health researchers to understand regional differences in health indices and outcomes, their relationship to regional cultural values, and opportunities for better interventions. To date we have had nine academic papers published or accepted in five academic journals.

Disability Prevalence (2021); Credit: John Liberty/Motivf for Nationhood Lab

Thanks to Nationhood Lab’s partners at Motivf, where John Liberty produced the maps you see here.

— Colin Woodard is director of Nationhood Lab at Salve Regina University’s Pell Center for International Relations and Public Policy.