Chapter 7.4 · The twilight · Report

Disability, retirement and Medicare

In CDC PLACES model estimates from 2022 survey responses, the share of adults with any disability was 23.3% in the least deprived tenth of census tracts and 42.9% in the most deprived.

Author: Vishal Singh
Affiliation: NYU Stern
Published: 9 October 2026

Every estimate of the chapter with its interval and every figure as a table, generated from the chapter's data files. Table n of this report is figure n of the chapter. The same report as Markdown: report.md.

Identification

Title

Disability, retirement and Medicare

Label

The twilight

Chapter

7.4 (Part VII, Health and care; An American life)

Question

How do disability, the mix of Social Security benefits, Medicare spending and life expectancy in old age differ by neighborhood and county income?

Dek

In CDC PLACES model estimates from 2022 survey responses, the share of adults with any disability was 23.3% in the least deprived tenth of census tracts and 42.9% in the most deprived.

Grain

neighborhoods

Status

published

Published

9 October 2026

Updated

not revised

Data sources

CDC PLACES. Any disability and all teeth lost among adults, census tracts, 2024 release (BRFSS 2022 responses); years: 2024 release (tracts); 2025 release (ZCTAs, 2023 data year); weights: adult population of the tract; estimated residents aged 65 and over for tooth loss
Area Deprivation Index. Area Deprivation Index national rank, 2023, tracts and ZCTAs; years: 2023 release (version 4.0.1; built on ACS 2019-2023); weights: none (index); the county rank is the population-weighted mean of tract ranks
American Community Survey. ACS 2019-2023 tract and ZCTA population, share aged 65 and over and median household income; years: 2019-2023 (5-year); weights: ACS population
SSA beneficiaries by ZIP code. OASDI beneficiaries and benefits by ZIP code, December 2024; years: December 2024; weights: none (full counts); beneficiaries or retired workers where pooled
IRS Statistics of Income. Taxable pensions and annuities by ZIP code, tax year 2022; years: tax year 2022; weights: none (full counts); dollars where pooled
Medicare Geographic Variation. Price-standardized Medicare payments, emergency department visits and service lines per Original Medicare beneficiary, county, 2024; years: 2024 (from the 2014-2024 file); weights: fee-for-service beneficiaries
County Health Rankings. County Health Rankings 2024: life expectancy (deaths 2019-2021), population and county measures; years: 2024 release; weights: county residents; each county once where stated
Health Inequality Project. Expected age at death at age 40 by national household-income quartile and sex, county, 2001-2014 (Online Data Table 11); years: 2001-2014 (pooled); weights: county residents (County Health Rankings 2024)

Canonical URL

https://vishalsingh.org/zipcode/disability-retirement-and-medicare

Markdown

https://vishalsingh.org/zipcode/disability-retirement-and-medicare/report.md

BibTeX

@misc{singh2026disabilityretirementandmedicare,
  author = {Singh, Vishal},
  title = {Disability, retirement and Medicare},
  year = {2026},
  url = {https://vishalsingh.org/zipcode/disability-retirement-and-medicare},
  note = {In ZIP Code Destiny. Published 9 October 2026.}
}

Principal estimates

The facts the dek and the opening prose cite, in order of appearance. Every fact is in the table of all estimates below.

Estimand	Population	Period	Value	Interval	n	Weights	Source	Fact id
mean of tract prevalence (crude, modeled), weighted by adult population, bootstrap interval over counties	adults in the least deprived tenth of tracts by ADI national rank	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	23.3%	95% CI 22.3% to 24.1%	8,274 tracts	adult population of the tract (PLACES)	CDC PLACES	dis_d1
mean of tract prevalence (crude, modeled), weighted by adult population, bootstrap interval over counties	adults in the most deprived tenth of tracts by ADI national rank	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	42.9%	95% CI 42.5% to 43.2%	8,213 tracts	adult population of the tract (PLACES)	CDC PLACES	dis_d10
share of the fifth's beneficiaries, pooled over its ZIP codes, bootstrap interval over counties	OASDI beneficiaries in the most deprived fifth of ZIP codes by ADI national rank	December 2024	16.8%	95% CI 16.4% to 17.3%	6,363 ZIP codes	beneficiaries (each ZIP code counts by its beneficiary count)	SSA beneficiaries by ZIP code	dis_q5
share of the fifth's beneficiaries, pooled over its ZIP codes, bootstrap interval over counties	OASDI beneficiaries in the least deprived fifth of ZIP codes by ADI national rank	December 2024	7.2%	95% CI 6.9% to 7.5%	6,363 ZIP codes	beneficiaries (each ZIP code counts by its beneficiary count)	SSA beneficiaries by ZIP code	dis_q1

Findings

The share of adults with any disability, as CDC PLACES models it from 2022 survey responses, was 42.9% (95% CI 42.5% to 43.2%) in the most deprived tenth of census tracts and 23.3% (95% CI 22.3% to 24.1%) in the least deprived. The PLACES model and the deprivation index both draw on American Community Survey data, so part of that gradient is built in. The share of Social Security beneficiaries who were disabled workers in December 2024 was 16.8% (95% CI 16.4% to 17.3%) in the most deprived fifth of ZIP codes and 7.2% (95% CI 6.9% to 7.5%) in the least deprived. This chapter follows those two gradients into the programs of old age. It asks whether Medicare payments per beneficiary and the expected age at death of the poorest income quartile also move with deprivation, at the grain of tracts, ZIP codes and counties.

Deprivation is measured by the Area Deprivation Index (ADI), a national percentile rank on which a higher value means a more deprived neighborhood.[1] The sources differ in kind. The Social Security and Medicare files are counts and payments from administrative records, while PLACES and the Health Inequality Project report modeled estimates. Every figure names its unit and its weights.

Disability rises with neighborhood deprivation, and age accounts for little of it

CDC PLACES estimates, for every census tract, the share of adults aged 18 and over who report difficulty with hearing, vision, thinking, walking, self-care or living independently, using survey responses from 2022 in its 2024 release.[2] Across 82,779 tracts, weighted by adult population, the share with any disability was 23.3% (95% CI 22.3% to 24.1%) in the least deprived tenth of tracts and 42.9% (95% CI 42.5% to 43.2%) in the most deprived, 1.8 (95% CI 1.8 to 1.9) times as high (Table 1).

Among adults aged 65 and over, the share who have lost all their teeth was 6.9% (95% CI 6.2% to 7.9%) and 25.1% (95% CI 24.7% to 25.6%), 3.6 (95% CI 3.2 to 4.0) times as high. The means of both measures rise at every step across the tenths, though the intervals of some neighboring tenths overlap, and tooth loss rises fastest at the deprived end. Across tracts, disability correlates +0.69 (95% CI 0.65 to 0.73) with the ADI rank.

PLACES does not count anyone. It fits a model to survey responses and applies it to each tract using census and American Community Survey inputs, and the ADI is built from American Community Survey data as well, so part of these gradients is built in. The tract file carries no intervals of its own, and the intervals here come from resampling counties.

A person has any disability if they report difficulty in at least one of the six areas. Values are crude prevalence, not adjusted for age, so a tract with more older residents would have a higher value if age mattered much.

The age of residents does not account for the gradient. Each ten-point step in the ADI rank goes with 2.0 (95% CI 1.8 to 2.1) points more disability, and holding the share of older residents fixed leaves the slope at 2.0 (95% CI 1.8 to 2.1).

Residents aged 65 and over were 17.3% (95% CI 16.6% to 18.0%) of the population in the least deprived tenth of tracts and 16.6% (95% CI 16.1% to 17.0%) in the most deprived. Across tracts, disability correlates only +0.07 (95% CI 0.04 to 0.10) with the share of older residents.

Disability was 30.5% (95% CI 29.6% to 31.3%) in the tenth of tracts with the fewest older residents (5.9% of residents) and 32.3% (95% CI 31.8% to 32.7%) in the tenth with the most (35.8%), a difference of 1.8 (95% CI 0.9 to 2.7) points.

Table 1. Adult disability is 23.3% in the least deprived tenth of census tracts and 42.9% in the most deprived, and it differs by 1.8 points between tenths of tracts with few and many older residents

Old-Age, Survivors and Disability Insurance pays benefits to retired workers, to disabled workers, to survivors (widows, widowers and parents of deceased workers), and to spouses and children. The Social Security Administration counts its beneficiaries by ZIP code. In December 2024 the 31,815 ZIP codes in the states and the District of Columbia that match a ZIP code area with an ADI rank held 65.9 million beneficiaries.

In the least deprived fifth of these ZIP codes, 80.5% (95% CI 79.9% to 81.1%) of beneficiaries were retired workers and 7.2% (95% CI 6.9% to 7.5%) were disabled workers. In the most deprived fifth, 65.9% (95% CI 65.3% to 66.4%) were retired workers and 16.8% (95% CI 16.4% to 17.3%) were disabled workers (Table 2).

The share of widows, widowers and parents is also larger in the most deprived fifth, 6.6% against 4.8%. So is the share of spouses and children, 10.7% against 7.5%.

A disabled worker's benefit becomes a retired worker's benefit at full retirement age. The retired-worker share therefore includes people who first qualified through disability, and the disabled-worker share counts only those still below full retirement age.

Table 2. Disabled workers are 16.8% of Social Security beneficiaries in the most deprived fifth of ZIP codes and 7.2% in the least deprived, and retired workers are 65.9% against 80.5%

Across ZIP codes, the disabled-worker share correlates +0.68 (95% CI 0.64 to 0.71) with the ADI rank when ZIP codes are weighted by population, and +0.52 (95% CI 0.50 to 0.54) when each counts once. Small ZIP codes, whose shares rest on few beneficiaries and counts that SSA rounds, count for more in the second correlation.

Among the 1,838 counties with at least 5,000 beneficiaries in their ZIP codes, the disabled-worker share is highest in Pike County, Kentucky (27.2%). The 12 counties with the highest shares, down to 23.0%, are all in Kentucky, Virginia and West Virginia.

The ranking depends on the cutoff. With a minimum of 10,000 beneficiaries, the 12 highest counties include counties in Alabama, Arkansas and Oklahoma as well as Kentucky and Virginia.

Deprivation and income carry separate information about the share. In a regression across ZIP codes with the ADI rank, median household income and the share of residents aged 65 and over, each in standard-deviation units, weighted by population, the disabled-worker share has a coefficient of 0.46 (95% CI 0.40 to 0.52) on the ADI rank and −0.36 (95% CI −0.42 to −0.30) on income.

The size of a retired worker's benefit follows ZIP code income

The Social Security benefit formula starts from a worker's earnings over a career, so the average benefit in a ZIP code should rise with the incomes of its residents. The average monthly retired-worker benefit was $1,554 (95% CI $1,523 to $1,586) in the tenth of ZIP codes with the lowest median household income and $2,370 (95% CI $2,354 to $2,386) in the tenth with the highest (Table 3).

Across 28,547 ZIP codes with at least 50 retired workers, the correlation between the average benefit and median household income is +0.84 (95% CI 0.83 to 0.85) weighted by population and +0.80 (95% CI 0.79 to 0.82) counting each ZIP code once.

In the regression above, with the average retired-worker benefit as the outcome, the coefficient on income is 0.89 (95% CI 0.80 to 0.98), the coefficient on the share of residents aged 65 and over is 0.16 (95% CI 0.14 to 0.18) and the coefficient on the ADI rank is 0.08 (95% CI −0.02 to 0.18), an interval that includes zero. The benefit amount moves with income and not with the ADI rank, while the disabled-worker share moves with both.

Table 3. The average monthly retired-worker benefit rises with ZIP code income, from $1,554 in the lowest tenth of ZIP codes to $2,370 in the highest, a correlation of +0.84

Social Security is one layer of retirement income. Taxable pensions and annuities reported on tax returns for 2022 include pensions from private and public employers. They were 41.7% (95% CI 41.0% to 42.4%) of the sum of those pensions and annualized Social Security benefits in the least deprived fifth of ZIP codes and 28.0% (95% CI 27.5% to 28.4%) in the most deprived. The two sources cover different years and different people, tax filers and beneficiaries, so the share is a rough index of how much retirement income comes from outside Social Security.

Medicare payments show no detectable difference across county deprivation, but their mix differs

The Medicare Geographic Variation file reports, for each county, Part A and Part B payments per beneficiary with local prices removed, called price-standardized payments.[3] The payments are per beneficiary enrolled in Original Medicare, the fee-for-service program, with both parts. Medicare Advantage enrollees, who were 54.5% of beneficiaries with both parts in these counties, are not in them. The file counts beneficiaries of all ages, including people under 65 who qualify through disability, and standardization does not adjust for how sick beneficiaries are. Across 3,128 counties with an ADI rank, covering 27.6 million fee-for-service beneficiaries, payments averaged $12,585 (95% CI $12,125 to $12,987) per beneficiary in 2024.

Ranking counties on a county ADI, the mean of its tracts' ranks weighted by population, payments were $12,680 (95% CI $11,997 to $13,194) in the least deprived fifth of counties and $13,176 (95% CI $12,517 to $13,785) in the most deprived. The difference of $496 (95% CI −$290 to $1406) has an interval that includes zero, so the data show no detectable difference, though the interval is wide (Table 4). The correlation between a county's payments and its ADI is −0.04 (95% CI −0.19 to 0.21) weighted by fee-for-service beneficiaries and +0.30 (95% CI 0.20 to 0.39) counting each county once.

The fifths are different kinds of counties. 87.3% of the beneficiaries in the most deprived fifth live in counties with fewer than 5,000 fee-for-service beneficiaries, against 3.1% in the least deprived fifth, so the comparison of fifth means sets mostly small counties against mostly large ones.

Among counties below that size, payments rise from $10,893 (95% CI $10,526 to $11,270) in the least deprived fifth to $13,295 (95% CI $12,601 to $13,903) in the most deprived, and the intervals do not overlap. Among larger counties they go from $12,736 (95% CI $12,046 to $13,250) to $12,359 (95% CI $11,830 to $12,916), and the intervals overlap. Small counties make up 97% of the counties in the most deprived fifth and carry little weight in the weighted correlation, which is part of why the two correlations disagree.

The total hides changes in its parts. Between the least and the most deprived fifth, payments for procedures, tests, imaging and treatments differ by −$738 (95% CI −$971 to −$475), from $2,508 to $1,770. Payments for evaluation and management visits, the category CMS uses for clinician visits in offices, hospitals and other settings, differ by −$430 (95% CI −$543 to −$296), from $1,333 to $903, which is 32% (95% CI 24% to 39%) lower.

Payments for skilled nursing facilities are $437 (95% CI $214 to $653) higher, from $865 to $1,302. Payments for hospital outpatient departments and surgery centers are $410 (95% CI $206 to $601) higher and for all other services $480 (95% CI $243 to $736) higher. The differences for inpatient hospital stays ($134 (95% CI −$12 to $315)) and for home health and hospice ($224 (95% CI −$56 to $511)) have intervals that include zero.

Emergency department visits are higher in the more deprived fifths, 571 (95% CI 556 to 584) per thousand beneficiaries in the least deprived and 677 (95% CI 656 to 694) in the most deprived, and a county's visit rate correlates +0.37 (95% CI 0.26 to 0.47) with its ADI. The means rise at every step, though the intervals of neighboring fifths overlap. Chapter 7.1, Health behaviors and the supply of care reports the supply of primary care physicians and the rate of preventable hospital stays by county deprivation.

Table 4. Price-standardized Medicare payments are $12,680 per fee-for-service beneficiary in the least deprived fifth of counties and $13,176 in the most deprived, a difference whose interval includes zero

Payments vary across counties far more than they vary across the fifths. Weighted by beneficiaries, the county at the 90th percentile of payments, $14,770, is at 1.42 (95% CI 1.34 to 1.49) times the county at the 10th percentile, $10,433. Fisher and colleagues compared Medicare beneficiaries across regions grouped by spending in a cohort study and found that those in higher-spending regions received more care without better health outcomes.[4]

Across the 3,057 counties that also have a life expectancy at birth in County Health Rankings, for deaths in 2019 to 2021, the correlation between county payments and life expectancy is −0.07 (95% CI −0.27 to 0.05) weighted by beneficiaries, with a slope of −0.12 (95% CI −0.51 to 0.08) years per thousand dollars. Counting each county once, the correlation is −0.35 (95% CI −0.43 to −0.25).

Holding the county ADI fixed, the slope is −0.17 (95% CI −0.33 to −0.01) years per thousand dollars weighted by beneficiaries and −0.28 (95% CI −0.40 to −0.16) counting each county once, so at a given level of deprivation life expectancy is slightly lower where payments are higher. The county ADI correlates −0.82 (95% CI −0.85 to −0.77) with life expectancy.

Weighted by residents, the poorest income quartile's expected age at death varies more across counties

The Health Inequality Project linked federal tax records to Social Security death records to estimate expected age at death for people who reach age 40, by household income, sex and county.[5] The file used here gives the estimate for each quartile of the national distribution of household income, from the poorest to the richest, in 1,559 larger counties, for 2001 to 2014, adjusted to the national racial composition. The file does not state its size threshold. Its smallest county has 15,304 residents and its median county 69,380, in the County Health Rankings 2024 release (a Census Bureau estimate for 2022).

The chapter averages the estimates for women and men. Weighted by county residents, the poorest quartile's expected age at death averaged 79.5 (95% CI 79.1 to 79.9) across counties and the richest quartile's 86.3 (95% CI 86.1 to 86.4), a difference of 6.7 (95% CI 6.3 to 7.2) years.

The poorest quartile's values run from 77.5 in the county at the 5th percentile to 81.8 in the county at the 95th (Table 5). Population-weighted state averages of the county values are lowest in Oklahoma, Nevada, Indiana, Wyoming, Kentucky, Michigan and Arkansas and highest in New York, Montana, California, Vermont, Massachusetts, Maine and Idaho, and Nevada and Wyoming have few counties in the file. The Project estimated only larger counties, 1,559 of them on this map, so the map is gray for the rest.

Table 5. Expected age at death at 40 for the poorest income quartile runs from 77.5 in the county at the fifth percentile to 81.8 in the county at the ninety-fifth

The richest quartile's expected age at death is higher than the poorest quartile's in 1,558 of the 1,559 counties (Table 6), but the poorest quartile's values vary more from county to county. Weighted by residents, the range from the 5th to the 95th percentile of counties is 4.3 (95% CI 3.7 to 4.9) years for the poorest quartile and 3.0 (95% CI 2.7 to 3.6) for the richest, a difference of 1.3 (95% CI 0.3 to 1.9) years whose interval excludes zero.

Among the 283 counties with at least 250,000 residents, the ranges are 4.2 (95% CI 3.5 to 5.0) and 2.6 (95% CI 2.3 to 3.4), a difference of 1.6 (95% CI 0.7 to 2.5) years.

Table 6. Weighted by residents, county values of expected age at death at 40 span 4.3 years between the 5th and 95th percentiles for the poorest income quartile and 3.0 for the richest

The comparison depends on the weights. Counting each county once, the ranges are 4.0 (95% CI 3.7 to 4.4) years for the poorest quartile and 4.3 (95% CI 3.9 to 4.6) for the richest, and the difference of −0.3 (95% CI −0.7 to 0.2) includes zero.

Estimates for the richest quartile rest on fewer deaths in small counties and are less precise, with a mean standard error of 0.9 years against 0.5 for the poorest quartile. Removing the mean squared standard error from the variance of the county values, and counting each county once, leaves a standard deviation of 1.13 (95% CI 1.00 to 1.24) years for the poorest quartile and 0.91 (95% CI 0.77 to 1.02) for the richest, a difference of 0.22 (95% CI 0.08 to 0.38) years whose interval excludes zero.

Without the race adjustment, the ranges are 6.4 (95% CI 4.7 to 6.7) years for the poorest quartile and 3.0 (95% CI 2.7 to 3.4) for the richest, so the adjustment shortens the poorest quartile's range and leaves the richest quartile's nearly unchanged.

The figure below sets expected age at death beside 15 county measures, the county ADI and measures from County Health Rankings (Table 7). Weighted by residents, the poorest quartile's expected age at death correlates −0.67 (95% CI −0.74 to −0.51) with the county ADI, −0.64 (95% CI −0.71 to −0.51) with the share of adults with obesity, −0.58 (95% CI −0.67 to −0.45) with the smoking rate, +0.48 (95% CI 0.38 to 0.55) with median household income and +0.32 (95% CI 0.25 to 0.40) with the share of adults with some college.

Counting each county once, the correlations are −0.44 (95% CI −0.53 to −0.34) with the ADI, −0.45 (95% CI −0.54 to −0.34) with obesity and −0.34 (95% CI −0.44 to −0.24) with smoking. The share of people under 65 without health insurance correlates −0.15 (95% CI −0.28 to 0.06) weighted and −0.16 (95% CI −0.29 to 0.01) counting each county once, intervals that include zero. Primary care physicians per hundred thousand residents correlate +0.28 (95% CI 0.20 to 0.35).

For the richest quartile, the county ADI correlates −0.22 (95% CI −0.43 to −0.07), the uninsured share −0.27 (95% CI −0.37 to −0.18) and physical inactivity −0.50 (95% CI −0.60 to −0.41). The Project's own analysis of local areas reported a correlation of −0.69 between life expectancy in the lowest income quartile and smoking, and no significant correlation with access to medical care.[5]

Table 7. Across counties weighted by residents, the poorest quartile's expected age at death correlates −0.67 with the county ADI, −0.64 with obesity and −0.58 with smoking, and −0.15 with the uninsured share

Causal evidenceRegression discontinuity; instrumental variables (examiner assignment); difference-in-differences

What eligibility rules and cash benefits change for the people they reach

The comparisons above are between places. Four studies ask what Medicare and Social Security change for the people who receive them, each with its own design.

Card, Dobkin and Maestas compared patients just below and just above age 65, when most people become eligible for Medicare. The patients were admitted to California hospitals through the emergency department with conditions whose admission rates did not differ between weekdays and weekends. In this regression discontinuity design, patients just past the threshold received more treatment and had lower mortality in the days after admission.[6]

Maestas, Mullen and Strand used the assignment of disability insurance applications to examiners who differ in how often they allow claims. An examiner's allowance rate served as an instrument for whether an applicant received benefits, an instrumental variables design, and applicants on the margin of allowance would have worked more had they not received benefits.[7] Deshpande, Gross and Su used two age thresholds in the disability determination rules at which the chance of allowance rises, in a design similar to a regression discontinuity, and found that allowance lowered the chances of bankruptcy and foreclosure for the applicants the thresholds affected.[8]

Snyder and Evans used the Social Security benefit notch, a change in the benefit formula that gave people born just before January 1917 larger benefits than people born just after it. They compared mortality across those birth cohorts, with other cohorts as controls, in a difference-in-differences design that the published paper pairs with a regression discontinuity. The cohort with the larger benefits had higher mortality, and the authors link the lower mortality of the smaller-benefit cohort to more work after retirement.[9]

These designs estimate what a program changes for the people it reaches at a threshold or on the margin of a decision. None of them estimates whether the programs would narrow the differences between places in this chapter.

Adult disability rises across tracts under all four rankings

Table 8 repeats the disability gradient under four rankings, over the 75,596 tracts that have all four. Ranked by the ADI, the share of adults with any disability is 23.1% (95% CI 22.1% to 23.9%) in the least deprived tenth and 42.6% (95% CI 42.2% to 43.0%) in the most deprived, and under the standardized index it is 21.4% (95% CI 21.0% to 21.8%) and 43.4% (95% CI 42.8% to 43.9%). Ranked by median household income it runs from 21.4% (95% CI 21.0% to 21.8%) to 42.9% (95% CI 42.6% to 43.3%), and by bachelor's degree share from 20.7% (95% CI 20.3% to 21.1%) to 42.0% (95% CI 41.6% to 42.5%), and under each ranking the tenth means rise in order (rank correlations of +1.00, +1.00 and +1.00). None of the three changes the gradient under the book's rule (Chapter 9.1, How far one ranking goes), and the PLACES model draws on ACS inputs that all four rankings share.

Table 8. Adult disability is steadily worse toward the more deprived end under the ADI and under each of the three other rankings

What these data cannot show

Every pattern here describes tracts, ZIP codes or counties, and a pattern across places need not hold for the people inside them (ecological inference). A ZIP code with a high disabled-worker share says nothing about whether any resident should receive a disability benefit, and a county's expected age at death for the poorest quartile is an estimate for a group of people who share an income rank, not a forecast for one of them.

The measures differ in vintage and in how they are made. PLACES values are modeled from 2022 survey responses, and their link with the ADI is partly built in. The Social Security counts are for December 2024 and are rounded by SSA, and the ZIP code is matched to the ZIP code area of the same number, which leaves out ZIP codes such as post office boxes. The Medicare payments are for 2024, cover only fee-for-service beneficiaries, and so leave out the Medicare Advantage enrollees, who are 54.5% of beneficiaries with both parts in these counties. They are not adjusted for the health of the beneficiaries, so equal payments do not mean equal care or equal need. The life-expectancy estimates describe deaths from 2001 to 2014 and end before the later years of this book, and household income is measured on a national scale that does not adjust for the cost of living where a household lives.

The correlates are measured years after the deaths, and smoking and obesity are County Health Rankings' modeled estimates for all adults, not for the poorest quartile. The Project's authors found that the share of immigrants was among the strongest correlates of low-income longevity across local areas, a pattern that tract and county measures of this kind cannot separate from place itself (see Chapter 9.5, Immigrants and the gradient (planned)). Weights matter for several results here. The Medicare correlations with deprivation and with life expectancy and the spread of the richest quartile's expected age at death all change when each county counts once, and both versions are reported.

None of the gradients tells what would move a number. The causal evidence above concerns eligibility rules, examiner decisions and a benefit notch, and the places in this chapter differ in many ways that those studies do not address.

Tables

Table 1. Adult disability is 23.3% in the least deprived tenth of census tracts and 42.9% in the most deprived, and it differs by 1.8 points between tenths of tracts with few and many older residents

Percent of adults with any disability and percent of older adults who have lost all their teeth, by tenth of the Area Deprivation Index, and disability against the share of older residents, census tracts, 2024 PLACES release

Table 1.1. By deprivation

Disability and tooth loss both rise across tenths of tracts by deprivation, tooth loss from 6.9% to 25.1% and disability from 23.3% to 42.9%

Percent of adults with any disability and percent of older adults who have lost all their teeth, by tenth of the Area Deprivation Index national rank, census tracts

conf_high	conf_low	decile	estimate	n	series
24.07	22.30	1	23.28	8,274	Any disability among adults
27.45	24.50	2	25.97	8,118	Any disability among adults
27.99	26.08	3	27	8,509	Any disability among adults
28.73	27.60	4	28.17	8,261	Any disability among adults
30.32	29.39	5	29.84	8,189	Any disability among adults
32.06	31.21	6	31.62	8,318	Any disability among adults
33.88	33.16	7	33.53	8,305	Any disability among adults
35.81	35.15	8	35.48	8,238	Any disability among adults
38.39	37.74	9	38.06	8,354	Any disability among adults
43.21	42.50	10	42.86	8,213	Any disability among adults
7.91	6.24	1	6.94	8,258	All teeth lost among older adults
9.17	7.72	2	8.48	8,111	All teeth lost among older adults
9.65	8.65	3	9.12	8,498	All teeth lost among older adults
10.29	9.66	4	9.97	8,251	All teeth lost among older adults
11.53	10.90	5	11.20	8,179	All teeth lost among older adults
12.90	12.32	6	12.61	8,299	All teeth lost among older adults
14.49	13.95	7	14.22	8,298	All teeth lost among older adults
16.51	15.96	8	16.23	8,214	All teeth lost among older adults
19.15	18.58	9	18.87	8,341	All teeth lost among older adults
25.56	24.65	10	25.10	8,213	All teeth lost among older adults

Table 1.2. By age structure

Tracts with many older residents have little more disability than tracts with few, 32.3% in the tenth with the most against 30.5% in the tenth with the fewest

Percent of adults with any disability against the share of residents who are older adults, one dot per sampled census tract, with means for tenths of tracts by age share

No inline rows: the values of Table 1.2 are in /data/disability-retirement-and-medicare/disability_by_age.json.

Note: PLACES values are modeled estimates built from survey responses with census and ACS inputs that overlap the Area Deprivation Index, so part of each gradient is built in. Values are crude prevalence among adults, not adjusted for age. The tract file has no intervals, and the bands and whiskers come from resampling counties.

Note: Any disability is difficulty with hearing, vision, thinking, walking, self-care or independent living reported by adults aged 18 and over, and older adults are those aged 65 and over. Tenths hold equal numbers of tracts, and a tract with no tooth-loss value is left out of that line.

Note: The dots in the second view are a random sample of 2,000 tracts inside the plotted range, drawn with a fixed seed (stated in the methods note); 398 tracts fall outside that range, and every estimate uses all tracts.

Note: Across all the tracts in the comparison, 30.9% of adults report any disability.

Source: CDC PLACES 2024 release (BRFSS 2022), ACS 2019-2023 and Area Deprivation Index 2023; modeled estimates, weighted by adult population

Data: vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/disability_gradient.json

Table 2. Disabled workers are 16.8% of Social Security beneficiaries in the most deprived fifth of ZIP codes and 7.2% in the least deprived, and retired workers are 65.9% against 80.5%

Share of OASDI beneficiaries by type, percent, ZIP codes in fifths of the Area Deprivation Index national rank, December 2024

Fifth of ZIP codes by ADI	Type of beneficiary	Share of beneficiaries (%)	Lower limit of the 95% interval	Upper limit of the 95% interval	ZIP codes	Beneficiaries
1 (least deprived)	Retired workers	80.5	79.9	81.0	6,363	23,011,380
1 (least deprived)	Disabled workers	7.2	6.9	7.5	6,363	23,011,380
1 (least deprived)	Widowed	4.8	4.7	4.9	6,363	23,011,380
1 (least deprived)	Spouses and children	7.5	7.2	7.8	6,363	23,011,380
2	Retired workers	77.2	76.9	77.6	6,363	17,037,990
2	Disabled workers	10.1	9.8	10.3	6,363	17,037,990
2	Widowed	5.1	5.0	5.1	6,363	17,037,990
2	Spouses and children	7.6	7.5	7.8	6,363	17,037,990
3	Retired workers	73.9	73.6	74.3	6,363	11,839,725
3	Disabled workers	12.3	12.1	12.5	6,363	11,839,725
3	Widowed	5.5	5.5	5.6	6,363	11,839,725
3	Spouses and children	8.3	8.1	8.4	6,363	11,839,725
4	Retired workers	70.4	70.0	70.7	6,363	8,506,535
4	Disabled workers	14.4	14.2	14.7	6,363	8,506,535
4	Widowed	6.1	6.0	6.2	6,363	8,506,535
4	Spouses and children	9.1	8.9	9.2	6,363	8,506,535
5 (most deprived)	Retired workers	65.8	65.3	66.4	6,363	5,518,365
5 (most deprived)	Disabled workers	16.8	16.4	17.3	6,363	5,518,365
5 (most deprived)	Widowed	6.6	6.5	6.8	6,363	5,518,365
5 (most deprived)	Spouses and children	10.7	10.4	10.9	6,363	5,518,365

Note: Types are the groups SSA reports: retired workers, disabled workers, widows, widowers and parents (survivors), and spouses and children. Disabled-worker benefits become retired-worker benefits at full retirement age, so former disabled workers are counted as retired workers after it.

Note: The figure covers 31,815 ZIP codes and 65.9 million beneficiaries that match a ZCTA with an ADI rank. A ZIP code is matched to the ZCTA of the same number (a ZIP code is not a ZCTA), and ZIP codes with no ZCTA, such as post office boxes, are left out. Connecticut ZIP codes are included. SSA rounds its counts and does not list ZIP codes below a disclosure threshold.

Source: SSA OASDI beneficiaries by ZIP code, December 2024, and Area Deprivation Index 2023; full counts, pooled over ZIP codes, intervals from a bootstrap over counties

Data: vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/oasdi_mix.json

Table 3. The average monthly retired-worker benefit rises with ZIP code income, from $1,554 in the lowest tenth of ZIP codes to $2,370 in the highest, a correlation of +0.84

Average monthly OASDI retired-worker benefit in dollars against median household income in dollars (log scale), one dot per sampled ZIP code area, with means for tenths of ZIP codes by income

No inline rows: the values of Table 3 are in /data/disability-retirement-and-medicare/benefit_vs_income.json.

Note: The average is the monthly benefit dollars paid to retired workers in a ZIP code divided by its retired workers, for December 2024. SSA reports benefit totals in thousands of dollars, converted here, and rounds them. ZIP code income is the ACS 2019-2023 median household income of the matching ZCTA, which the Census Bureau tops out at a ceiling, and ZIP codes without an income are left out.

Note: The dots are drawn at random from the ZIP codes inside the plotted range with a fixed seed (stated in the methods note); every estimate uses all ZIP codes. The correlation weights ZIP codes by population; counting each ZIP code once gives +0.80.

Source: SSA OASDI beneficiaries by ZIP code, December 2024, and ACS 2019-2023 ZCTA median household income; full counts of benefits, weighted by retired workers, intervals from a bootstrap over counties

Data: vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/benefit_vs_income.json

Table 4. Price-standardized Medicare payments are $12,680 per fee-for-service beneficiary in the least deprived fifth of counties and $13,176 in the most deprived, a difference whose interval includes zero

Medicare Part A and Part B payments per Original Medicare beneficiary with local prices removed, by fifth of the county Area Deprivation Index, service lines, emergency department visits and county life expectancy, 2024

Table 4.1. Service lines

Payments for procedures, tests, imaging and treatments fall from $2,508 to $1,770 across fifths of counties while payments for skilled nursing facilities rise from $865 to $1,302

Price-standardized payments per fee-for-service beneficiary by service line, dollars per year, fifths of counties by the county Area Deprivation Index

Fifth of counties by ADI	Service line	Dollars per beneficiary	Lower limit of the 95% interval	Upper limit of the 95% interval	Counties
1 (least deprived)	Inpatient hospital stays	2,871	2,712	3,001	605
2	Inpatient hospital stays	2,869	2,765	2,963	585
3	Inpatient hospital stays	2,913	2,812	2,993	571
4	Inpatient hospital stays	2,955	2,858	3,036	565
5 (most deprived)	Inpatient hospital stays	3,005	2,919	3,073	541
1 (least deprived)	Hospital outpatient and surgery centers	2,516	2,401	2,684	605
2	Hospital outpatient and surgery centers	2,780	2,618	2,953	585
3	Hospital outpatient and surgery centers	2,864	2,708	3,035	571
4	Hospital outpatient and surgery centers	3,002	2,793	3,201	565
5 (most deprived)	Hospital outpatient and surgery centers	2,926	2,768	3,098	541
1 (least deprived)	Skilled nursing facilities	865	712	986	605
2	Skilled nursing facilities	771	721	829	585
3	Skilled nursing facilities	879	831	928	571
4	Skilled nursing facilities	1,004	925	1,081	565
5 (most deprived)	Skilled nursing facilities	1,302	1,122	1,462	541
1 (least deprived)	Home health and hospice	1,010	839	1,148	605
2	Home health and hospice	962	853	1,066	585
3	Home health and hospice	1,018	864	1,187	571
4	Home health and hospice	1,060	896	1,228	565
5 (most deprived)	Home health and hospice	1,234	975	1,460	541
1 (least deprived)	Evaluation and management visits	1,333	1,218	1,426	605
2	Evaluation and management visits	1,146	1,062	1,219	585
3	Evaluation and management visits	1,054	992	1,102	571
4	Evaluation and management visits	967	902	1,028	565
5 (most deprived)	Evaluation and management visits	903	831	967	541
1 (least deprived)	Procedures, tests, imaging and treatments	2,508	2,275	2,723	605
2	Procedures, tests, imaging and treatments	2,204	2,011	2,399	585
3	Procedures, tests, imaging and treatments	1,938	1,808	2,073	571
4	Procedures, tests, imaging and treatments	1,786	1,655	1,936	565
5 (most deprived)	Procedures, tests, imaging and treatments	1,770	1,635	1,884	541
1 (least deprived)	All other services	1,578	1,375	1,745	605
2	All other services	1,639	1,456	1,830	585
3	All other services	1,724	1,544	1,922	571
4	All other services	1,776	1,622	1,931	565
5 (most deprived)	All other services	2,058	1,863	2,226	541

Table 4.2. Life expectancy

Weighted by beneficiaries, county life expectancy has no clear relation to payments per beneficiary, a correlation of −0.07, but counting each county once the correlation is −0.35

County life expectancy at birth in years against price-standardized Medicare payments per fee-for-service beneficiary in dollars, one dot per county, dot area is beneficiaries, with means for tenths of counties by payments

No inline rows: the values of Table 4.2 are in /data/disability-retirement-and-medicare/spend_vs_life_expectancy.json.

Table 4.3. Emergency visits

Emergency department visits are higher in the more deprived fifths of counties, from 571 in the least deprived to 677 in the most deprived per thousand fee-for-service beneficiaries

Emergency department visits per thousand fee-for-service beneficiaries per year, fifths of counties by the county Area Deprivation Index

conf_high	conf_low	fifth	n	visits
584	555.5	1 (least deprived)	625	570.5
617.4	582.1	2	625	598.9
635.5	603	3	626	620.1
655.4	627.3	4	628	642.1
693.6	656.4	5 (most deprived)	624	676.7

Note: Payments are CMS price-standardized Part A and Part B payments per capita for beneficiaries enrolled in Original Medicare with both parts, so Medicare Advantage enrollees, who are 54.5% of beneficiaries with both parts in these counties, are not in them. Standardization removes local price differences and does not adjust for how sick beneficiaries are. The file counts beneficiaries of all ages, including those under 65 who qualify through disability.

Note: A fifth holds equal numbers of counties, ranked on the county Area Deprivation Index (the mean of its tracts' ranks, weighted by population). Intervals resample whole states. Connecticut is by planning region. The service lines view leaves out counties for which CMS blanks a line, and its last segment is the total minus the lines shown. Evaluation and management visits are CMS's category for visits to physicians and other clinicians in many settings, among them offices, hospitals, nursing facilities, homes and emergency departments.

Note: Life expectancy is the County Health Rankings 2024 estimate computed from NCHS death counts. Connecticut is left out of the second view because that file uses its legacy counties.

Note: Across all the counties in the comparison, there are 592 emergency department visits per thousand fee-for-service beneficiaries per year.

Source: CMS Medicare Geographic Variation, county, 2024, and Area Deprivation Index 2023; price-standardized payments per fee-for-service beneficiary, weighted by fee-for-service beneficiaries, full counts (life expectancy from County Health Rankings 2024, deaths 2019-2021, full counts)

Data: vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/medicare_spending.json

Table 5. Expected age at death at 40 for the poorest income quartile runs from 77.5 in the county at the fifth percentile to 81.8 in the county at the ninety-fifth

Expected age at death in years for people who reach age 40 in the lowest quartile of national household income, 2001 to 2014, counties in the Health Inequality Project file

No inline rows: the values of Table 5 are in /data/disability-retirement-and-medicare/poor_le_map.json.

Note: The Project estimated only the larger counties, so 1,559 counties are drawn with a value and the rest are gray with the reason in the tooltip. A gray county was not estimated; it is not a county with a low value.

Note: Each value comes from a bootstrap estimate with a standard error given in the tooltip, and small counties are noisy. Connecticut is shown by its eight legacy counties, as in the Project's file. Puerto Rico is not drawn.

Source: Health Inequality Project county expected age at death, 2001-2014 (Online Data Table 11); modeled estimates, race-adjusted, average of women and men; county residents from the County Health Rankings 2024 release

Data: vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/poor_le_map.json

Table 6. Weighted by residents, county values of expected age at death at 40 span 4.3 years between the 5th and 95th percentiles for the poorest income quartile and 3.0 for the richest

Expected age at death in years for people who reach age 40 in the poorest quartile against the richest quartile of national household income, one dot per county, dot area is county residents, 2001 to 2014

No inline rows: the values of Table 6 are in /data/disability-retirement-and-medicare/poor_vs_rich_le_at_40.json.

Note: The richest quartile's estimates rest on fewer deaths in small counties and carry larger standard errors: the mean standard error of a county's value is 0.9 years for the richest quartile and 0.5 years for the poorest. Counting each county once, the range is 4.0 years for the poorest quartile and 4.3 for the richest, and among counties of at least 250,000 residents it is 4.2 against 2.6.

Note: Values are adjusted to the national racial composition and averaged over women and men. Without the race adjustment, the range across counties is 6.4 years for the poorest quartile and 3.0 for the richest. The ranges run from the 5th to the 95th percentile of counties, weighted by county residents, and their intervals resample whole states.

Note: Weights and dot areas are county residents in the County Health Rankings 2024 release, a Census Bureau estimate for 2022 and the nearest population available, while the estimates are for 2001 to 2014. The file covers 1,559 larger counties.

Source: Health Inequality Project county expected age at death, 2001-2014 (Online Data Table 11); modeled estimates, race-adjusted, average of women and men; weighted by county residents (County Health Rankings 2024 release)

Data: vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/poor_vs_rich_le_at_40.json

Table 7. Across counties weighted by residents, the poorest quartile's expected age at death correlates −0.67 with the county ADI, −0.64 with obesity and −0.58 with smoking, and −0.15 with the uninsured share

Correlation across counties of expected age at death at age 40 in the poorest and the richest income quartile with 15 county measures, 2001 to 2014 deaths and 2018 to 2023 measures, with 95% intervals

conf_high	conf_low	estimate	measure	n	quartile	weighting
0.547	0.376	0.478	Median household income	1,559	Poorest quartile	Population-weighted
0.366	0.197	0.290	Median household income	1,559	Poorest quartile	Each county once
0.382	0.171	0.266	Median household income	1,559	Richest quartile	Population-weighted
0.355	0.255	0.308	Median household income	1,559	Richest quartile	Each county once
0.403	0.247	0.324	Adults with some college	1,559	Poorest quartile	Population-weighted
0.305	0.156	0.235	Adults with some college	1,559	Poorest quartile	Each county once
0.527	0.380	0.456	Adults with some college	1,559	Richest quartile	Population-weighted
0.453	0.356	0.407	Adults with some college	1,559	Richest quartile	Each county once
0.346	0.205	0.277	Primary care physicians per 100,000 residents	1,559	Poorest quartile	Population-weighted
0.330	0.199	0.264	Primary care physicians per 100,000 residents	1,559	Poorest quartile	Each county once
0.491	0.339	0.418	Primary care physicians per 100,000 residents	1,559	Richest quartile	Population-weighted
0.407	0.317	0.363	Primary care physicians per 100,000 residents	1,559	Richest quartile	Each county once
0.468	0.025	0.273	Residents who are Hispanic	1,559	Poorest quartile	Population-weighted
0.250	−0.138	0.032	Residents who are Hispanic	1,559	Poorest quartile	Each county once
−0.117	−0.404	−0.300	Residents who are Hispanic	1,559	Richest quartile	Population-weighted
0.040	−0.270	−0.125	Residents who are Hispanic	1,559	Richest quartile	Each county once
0.321	−0.010	0.195	Ratio of 80th to 20th percentile household income	1,545	Poorest quartile	Population-weighted
0.098	−0.094	0	Ratio of 80th to 20th percentile household income	1,545	Poorest quartile	Each county once
−0.008	−0.216	−0.125	Ratio of 80th to 20th percentile household income	1,545	Richest quartile	Population-weighted
−0.051	−0.222	−0.145	Ratio of 80th to 20th percentile household income	1,545	Richest quartile	Each county once
0.169	−0.198	0.025	Unemployment rate	1,559	Poorest quartile	Population-weighted
0.086	−0.147	−0.023	Unemployment rate	1,559	Poorest quartile	Each county once
−0.232	−0.443	−0.343	Unemployment rate	1,559	Richest quartile	Population-weighted
−0.135	−0.366	−0.249	Unemployment rate	1,559	Richest quartile	Each county once
0.026	−0.271	−0.126	Residents who are non-Hispanic Black	1,559	Poorest quartile	Population-weighted
−0.005	−0.179	−0.084	Residents who are non-Hispanic Black	1,559	Poorest quartile	Each county once
−0.038	−0.248	−0.130	Residents who are non-Hispanic Black	1,559	Richest quartile	Population-weighted
−0.075	−0.255	−0.162	Residents who are non-Hispanic Black	1,559	Richest quartile	Each county once
0.057	−0.280	−0.151	People under 65 without health insurance	1,559	Poorest quartile	Population-weighted
0.011	−0.290	−0.157	People under 65 without health insurance	1,559	Poorest quartile	Each county once
−0.179	−0.369	−0.272	People under 65 without health insurance	1,559	Richest quartile	Population-weighted
−0.165	−0.363	−0.271	People under 65 without health insurance	1,559	Richest quartile	Each county once
−0.050	−0.316	−0.218	Residents living in rural areas	1,559	Poorest quartile	Population-weighted
0.133	−0.076	0.023	Residents living in rural areas	1,559	Poorest quartile	Each county once
0.060	−0.158	−0.046	Residents living in rural areas	1,559	Richest quartile	Population-weighted
−0.068	−0.204	−0.136	Residents living in rural areas	1,559	Richest quartile	Each county once
−0.122	−0.358	−0.241	Children in poverty	1,559	Poorest quartile	Population-weighted
−0.138	−0.287	−0.211	Children in poverty	1,559	Poorest quartile	Each county once
−0.309	−0.454	−0.383	Children in poverty	1,559	Richest quartile	Population-weighted
−0.335	−0.450	−0.395	Children in poverty	1,559	Richest quartile	Each county once
−0.155	−0.532	−0.355	Adults with no leisure-time physical activity	1,559	Poorest quartile	Population-weighted
−0.311	−0.478	−0.401	Adults with no leisure-time physical activity	1,559	Poorest quartile	Each county once
−0.412	−0.603	−0.504	Adults with no leisure-time physical activity	1,559	Richest quartile	Population-weighted
−0.428	−0.533	−0.485	Adults with no leisure-time physical activity	1,559	Richest quartile	Each county once
−0.223	−0.511	−0.379	Preventable hospital stays per 100,000 Medicare enrollees	1,557	Poorest quartile	Population-weighted
−0.281	−0.439	−0.360	Preventable hospital stays per 100,000 Medicare enrollees	1,557	Poorest quartile	Each county once
−0.279	−0.485	−0.375	Preventable hospital stays per 100,000 Medicare enrollees	1,557	Richest quartile	Population-weighted
−0.274	−0.387	−0.333	Preventable hospital stays per 100,000 Medicare enrollees	1,557	Richest quartile	Each county once
−0.451	−0.670	−0.576	Adults who smoke	1,559	Poorest quartile	Population-weighted
−0.243	−0.436	−0.343	Adults who smoke	1,559	Poorest quartile	Each county once
−0.137	−0.453	−0.273	Adults who smoke	1,559	Richest quartile	Population-weighted
−0.298	−0.442	−0.372	Adults who smoke	1,559	Richest quartile	Each county once
−0.510	−0.707	−0.642	Adults with obesity	1,559	Poorest quartile	Population-weighted
−0.340	−0.536	−0.446	Adults with obesity	1,559	Poorest quartile	Each county once
−0.204	−0.476	−0.320	Adults with obesity	1,559	Richest quartile	Population-weighted
−0.320	−0.449	−0.388	Adults with obesity	1,559	Richest quartile	Each county once
−0.510	−0.744	−0.670	Area Deprivation Index of the county (national rank)	1,559	Poorest quartile	Population-weighted
−0.338	−0.532	−0.442	Area Deprivation Index of the county (national rank)	1,559	Poorest quartile	Each county once
−0.075	−0.427	−0.218	Area Deprivation Index of the county (national rank)	1,559	Richest quartile	Population-weighted
−0.277	−0.414	−0.350	Area Deprivation Index of the county (national rank)	1,559	Richest quartile	Each county once

Views: Weighted by county residents (weighting = Population-weighted); Each county once (weighting = Each county once).

Note: The measures are for 2018 to 2023, after the 2001 to 2014 window of the life-expectancy estimates, and smoking, obesity and physical inactivity are County Health Rankings' modeled estimates for all adults, not for the poorest quartile. The county ADI is the mean of its tracts' ranks (2023), and part of the other measures overlaps its inputs. A correlation across counties does not say that smoking or obesity shortens the lives of the poor.

Note: Expected age at death is adjusted to the national racial composition and averaged over women and men. The two views use the same 1,559 counties wherever a measure exists.

Source: Health Inequality Project county expected age at death, 2001-2014 (Online Data Table 11); modeled estimates, race-adjusted, average of women and men; county measures from County Health Rankings 2024; population-weighted or unweighted as labeled

Data: vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/poor_le_correlates.json

Table 8. Adult disability is steadily worse toward the more deprived end under the ADI and under each of the three other rankings

Adults with any disability (percent of adults) by tenth of tracts ranked four ways, over the 75,596 tracts that have all four rankings

bin	conf_high	conf_low	estimate	n_units	ranking
1	23.86	22.11	23.11	7,551	Area Deprivation Index
2	27.45	24.67	26.07	7,563	Area Deprivation Index
3	27.80	26.08	26.89	7,489	Area Deprivation Index
4	28.81	27.74	28.27	7,757	Area Deprivation Index
5	30.38	29.43	29.89	7,485	Area Deprivation Index
6	32.07	31.22	31.62	7,513	Area Deprivation Index
7	33.81	33.13	33.47	7,658	Area Deprivation Index
8	35.76	35.11	35.45	7,419	Area Deprivation Index
9	38.27	37.59	37.93	7,618	Area Deprivation Index
10	42.96	42.22	42.60	7,543	Area Deprivation Index
1	21.79	21.00	21.39	7,559	Standardized index
2	24.62	23.97	24.29	7,560	Standardized index
3	26.93	26.29	26.61	7,559	Standardized index
4	28.80	28.25	28.53	7,560	Standardized index
5	30.60	30.08	30.33	7,560	Standardized index
6	32.31	31.76	32.03	7,559	Standardized index
7	34.19	33.53	33.85	7,560	Standardized index
8	36.26	35.58	35.92	7,559	Standardized index
9	38.87	38.05	38.48	7,560	Standardized index
10	43.92	42.84	43.38	7,560	Standardized index
1	21.83	21.04	21.41	7,560	Median household income
2	25.04	24.40	24.72	7,558	Median household income
3	27.25	26.66	26.95	7,560	Median household income
4	29.02	28.45	28.74	7,560	Median household income
5	30.72	30.15	30.44	7,560	Median household income
6	32.41	31.87	32.14	7,560	Median household income
7	34.19	33.68	33.94	7,555	Median household income
8	36.11	35.56	35.84	7,564	Median household income
9	38.72	38.13	38.44	7,560	Median household income
10	43.26	42.57	42.92	7,559	Median household income
1	21.12	20.26	20.67	7,558	Bachelor's degree share
2	24.64	24.06	24.35	7,557	Bachelor's degree share
3	27.00	26.49	26.75	7,566	Bachelor's degree share
4	28.94	28.48	28.70	7,560	Bachelor's degree share
5	30.85	30.36	30.60	7,553	Bachelor's degree share
6	32.51	32.04	32.27	7,559	Bachelor's degree share
7	34.31	33.85	34.09	7,562	Bachelor's degree share
8	36.23	35.73	35.98	7,569	Bachelor's degree share
9	38.57	37.96	38.28	7,548	Bachelor's degree share
10	42.46	41.62	42.05	7,564	Bachelor's degree share

Note: Least and most deprived tenth: ADI 23.1% and 42.6%, rank correlation +1.00; standardized index 21.4% and 43.4%, +1.00; median household income 21.4% and 42.9%, +1.00; bachelor's degree share 20.7% and 42.0%, +1.00.

Note: The standardized index applies the ADI's coefficients to its measures after standardizing each one, so home value and income carry less weight than in the ADI. Income and degree share are single census measures, each ranked from the highest value to the lowest.

Source: CDC PLACES 2024 release (BRFSS 2022), ACS 2019-2023 and Area Deprivation Index 2023; modeled estimates, weighted by adult population; ADI 2023 and ACS 2019-2023 tract tables (B19013, B15003 and the 15 rebuilt ADI measures)

Data: vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/alt_rankings.json

All estimates

Every fact in facts.json (165), sorted by id. The same values as JSON: facts.json.

Fact id	Value	Unit	Estimand	Population	Period	Interval	n	Weights	Source	Note
age65_d1	17.3%	percent of residents aged 65 and over	mean of the tract share aged 65 and over, weighted by tract population, bootstrap interval over counties	residents of the least deprived tenth of tracts by ADI national rank	ACS 2019-2023; ADI 2023	95% CI 16.6% to 18.0%	8,274 tracts	ACS 2019-2023 tract population	American Community Survey
age65_d10	16.6%	percent of residents aged 65 and over	mean of the tract share aged 65 and over, weighted by tract population, bootstrap interval over counties	residents of the most deprived tenth of tracts by ADI national rank	ACS 2019-2023; ADI 2023	95% CI 16.1% to 17.0%	8,213 tracts	ACS 2019-2023 tract population	American Community Survey
age_adult	18	years of age	age at which a person is counted as an adult in PLACES (a definition)	adults counted in the PLACES disability measure	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023			none (definition)	CDC PLACES
age_dec_hi	35.8%	percent of residents aged 65 and over	mean of the tract share aged 65 and over, weighted by adult population	residents of the tenth of tracts with the most residents aged 65 and over	ACS 2019-2023		8,286 tracts	adult population of the tract (PLACES)	American Community Survey
age_dec_lo	5.9%	percent of residents aged 65 and over	mean of the tract share aged 65 and over, weighted by adult population	residents of the tenth of tracts with the fewest residents aged 65 and over	ACS 2019-2023		8,275 tracts	adult population of the tract (PLACES)	American Community Survey
age_senior	65	years of age	age at which an adult is counted as older in these measures (a definition)	adults counted as older adults in PLACES tooth loss, in the ACS age share and in the Social Security aged-65-and-over counts	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023			none (definition)	CDC PLACES
alt_adi_least	23.1%	Adults with any disability (percent of adults)	adult-weighted mean of tract disability prevalence (crude, modeled); 95% intervals from a bootstrap over counties	the least deprived tenth of tracts ranked by Area Deprivation Index, among the tracts with all four rankings	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023; ACS 2019-2023	95% CI 22.1% to 23.9%	7,551 tracts	adult population of the tract (PLACES)	CDC PLACES
alt_adi_most	42.6%	Adults with any disability (percent of adults)	adult-weighted mean of tract disability prevalence (crude, modeled); 95% intervals from a bootstrap over counties	the most deprived tenth of tracts ranked by Area Deprivation Index, among the tracts with all four rankings	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023; ACS 2019-2023	95% CI 42.2% to 43.0%	7,543 tracts	adult population of the tract (PLACES)	CDC PLACES
alt_adi_rho	+1.00	rank correlation	Spearman rank correlation between bin order and bin mean, each bin counted once	the bins of tracts ranked by Area Deprivation Index	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023; ACS 2019-2023			each bin counted once	CDC PLACES
alt_degree_least	20.7%	Adults with any disability (percent of adults)	adult-weighted mean of tract disability prevalence (crude, modeled); 95% intervals from a bootstrap over counties	the least deprived tenth of tracts ranked by Bachelor's degree share, among the tracts with all four rankings	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023; ACS 2019-2023	95% CI 20.3% to 21.1%	7,558 tracts	adult population of the tract (PLACES)	CDC PLACES
alt_degree_most	42.0%	Adults with any disability (percent of adults)	adult-weighted mean of tract disability prevalence (crude, modeled); 95% intervals from a bootstrap over counties	the most deprived tenth of tracts ranked by Bachelor's degree share, among the tracts with all four rankings	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023; ACS 2019-2023	95% CI 41.6% to 42.5%	7,564 tracts	adult population of the tract (PLACES)	CDC PLACES
alt_degree_rho	+1.00	rank correlation	Spearman rank correlation between bin order and bin mean, each bin counted once	the bins of tracts ranked by Bachelor's degree share	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023; ACS 2019-2023			each bin counted once	CDC PLACES
alt_income_least	21.4%	Adults with any disability (percent of adults)	adult-weighted mean of tract disability prevalence (crude, modeled); 95% intervals from a bootstrap over counties	the least deprived tenth of tracts ranked by Median household income, among the tracts with all four rankings	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023; ACS 2019-2023	95% CI 21.0% to 21.8%	7,560 tracts	adult population of the tract (PLACES)	CDC PLACES
alt_income_most	42.9%	Adults with any disability (percent of adults)	adult-weighted mean of tract disability prevalence (crude, modeled); 95% intervals from a bootstrap over counties	the most deprived tenth of tracts ranked by Median household income, among the tracts with all four rankings	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023; ACS 2019-2023	95% CI 42.6% to 43.3%	7,559 tracts	adult population of the tract (PLACES)	CDC PLACES
alt_income_rho	+1.00	rank correlation	Spearman rank correlation between bin order and bin mean, each bin counted once	the bins of tracts ranked by Median household income	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023; ACS 2019-2023			each bin counted once	CDC PLACES
alt_n_places	75,596	tracts	count of tracts in the common sample of the ranking comparison	tracts with the outcome and all four rankings	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023; ACS 2019-2023			none (full count)	CDC PLACES
alt_rho_cut	0.9	absolute rank correlation	threshold between a steady and an uneven gradient	the rule for changed gradients (docs/RANKING_SWITCH_RULE.md)	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023; ACS 2019-2023			none (a fixed rule)	CDC PLACES
alt_rho_margin	0.1	absolute rank correlation	smallest move in the rank correlation that counts as a change of shape	the rule for changed gradients (docs/RANKING_SWITCH_RULE.md)	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023; ACS 2019-2023			none (a fixed rule)	CDC PLACES
alt_std_least	21.4%	Adults with any disability (percent of adults)	adult-weighted mean of tract disability prevalence (crude, modeled); 95% intervals from a bootstrap over counties	the least deprived tenth of tracts ranked by Standardized index, among the tracts with all four rankings	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023; ACS 2019-2023	95% CI 21.0% to 21.8%	7,559 tracts	adult population of the tract (PLACES)	CDC PLACES
alt_std_most	43.4%	Adults with any disability (percent of adults)	adult-weighted mean of tract disability prevalence (crude, modeled); 95% intervals from a bootstrap over counties	the most deprived tenth of tracts ranked by Standardized index, among the tracts with all four rankings	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023; ACS 2019-2023	95% CI 42.8% to 43.9%	7,560 tracts	adult population of the tract (PLACES)	CDC PLACES
alt_std_rho	+1.00	rank correlation	Spearman rank correlation between bin order and bin mean, each bin counted once	the bins of tracts ranked by Standardized index	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023; ACS 2019-2023			each bin counted once	CDC PLACES
belt_k	12	counties	number of counties whose names the text gives	counties with the highest disabled-worker share	December 2024			none (rule)	SSA beneficiaries by ZIP code
belt_kth	23.0%	percent of OASDI beneficiaries who are disabled workers	disabled workers divided by all beneficiaries in the county's ZIP codes	OASDI beneficiaries in the county with the twelfth-highest disabled-worker share among counties with at least 5,000 beneficiaries	December 2024		6,980 OASDI beneficiaries	none (full count)	SSA beneficiaries by ZIP code
belt_min	5,000	OASDI beneficiaries	minimum number of beneficiaries for a county to enter the ranking	counties in the county ranking of disabled-worker shares	December 2024			none (inclusion rule)	SSA beneficiaries by ZIP code
belt_min_alt	10,000	OASDI beneficiaries	alternative minimum number of beneficiaries for a county to enter the ranking	counties in the check of the county ranking of disabled-worker shares	December 2024			none (inclusion rule)	SSA beneficiaries by ZIP code
belt_top	27.2%	percent of OASDI beneficiaries who are disabled workers	disabled workers divided by all beneficiaries in the county's ZIP codes	OASDI beneficiaries in the county with the highest disabled-worker share among counties with at least 5,000 beneficiaries	December 2024		15,925 OASDI beneficiaries	none (full count)	SSA beneficiaries by ZIP code
ben_inc_d1	$1,554	dollars per month, average retired-worker benefit	benefit dollars divided by retired workers, pooled over the tenth's ZIP codes (benefit totals in thousands of dollars converted to dollars; SSA rounds the totals), bootstrap interval over counties	retired workers in the lowest tenth of ZIP codes by median household income	December 2024	95% CI $1,523 to $1,586	2,863 ZIP codes	retired workers	SSA beneficiaries by ZIP code
ben_inc_d10	$2,370	dollars per month, average retired-worker benefit	benefit dollars divided by retired workers, pooled over the tenth's ZIP codes (benefit totals in thousands of dollars converted to dollars; SSA rounds the totals), bootstrap interval over counties	retired workers in the highest tenth of ZIP codes by median household income	December 2024	95% CI $2,354 to $2,386	2,855 ZIP codes	retired workers	SSA beneficiaries by ZIP code
beta_ben_adi	0.08	standard deviations of the outcome per standard deviation of the predictor	standardized coefficient on the ADI national rank for the average monthly retired-worker benefit in a regression on the ADI rank, median income and share aged 65 and over, weighted by ZIP-code population, errors clustered on county	ZIP codes in the 50 states and DC with the outcome, ADI, median household income and share aged 65 and over	OASDI December 2024; ACS 2019-2023; ADI 2023	95% CI −0.02 to 0.18	28,547 ZIP codes	ACS 2019-2023 ZCTA population	SSA beneficiaries by ZIP code
beta_ben_age	0.16	standard deviations of the outcome per standard deviation of the predictor	standardized coefficient on the share of residents aged 65 and over for the average monthly retired-worker benefit in a regression on the ADI rank, median income and share aged 65 and over, weighted by ZIP-code population, errors clustered on county	ZIP codes in the 50 states and DC with the outcome, ADI, median household income and share aged 65 and over	OASDI December 2024; ACS 2019-2023; ADI 2023	95% CI 0.14 to 0.18	28,547 ZIP codes	ACS 2019-2023 ZCTA population	SSA beneficiaries by ZIP code
beta_ben_inc	0.89	standard deviations of the outcome per standard deviation of the predictor	standardized coefficient on ZIP median household income for the average monthly retired-worker benefit in a regression on the ADI rank, median income and share aged 65 and over, weighted by ZIP-code population, errors clustered on county	ZIP codes in the 50 states and DC with the outcome, ADI, median household income and share aged 65 and over	OASDI December 2024; ACS 2019-2023; ADI 2023	95% CI 0.80 to 0.98	28,547 ZIP codes	ACS 2019-2023 ZCTA population	SSA beneficiaries by ZIP code
beta_dis_adi	0.46	standard deviations of the outcome per standard deviation of the predictor	standardized coefficient on the ADI national rank for a ZIP code's disabled-worker share of OASDI beneficiaries in a regression on the ADI rank, median income and share aged 65 and over, weighted by ZIP-code population, errors clustered on county	ZIP codes in the 50 states and DC with the outcome, ADI, median household income and share aged 65 and over	OASDI December 2024; ACS 2019-2023; ADI 2023	95% CI 0.40 to 0.52	30,103 ZIP codes	ACS 2019-2023 ZCTA population	SSA beneficiaries by ZIP code
beta_dis_inc	−0.36	standard deviations of the outcome per standard deviation of the predictor	standardized coefficient on ZIP median household income for a ZIP code's disabled-worker share of OASDI beneficiaries in a regression on the ADI rank, median income and share aged 65 and over, weighted by ZIP-code population, errors clustered on county	ZIP codes in the 50 states and DC with the outcome, ADI, median household income and share aged 65 and over	OASDI December 2024; ACS 2019-2023; ADI 2023	95% CI −0.42 to −0.30	30,103 ZIP codes	ACS 2019-2023 ZCTA population	SSA beneficiaries by ZIP code
big_pop	250,000	residents	county population at or above which a county is called large in the check	counties in the larger-county check	2022 estimate in the County Health Rankings 2024 release			none (cutoff)	County Health Rankings
chetty_r_smoke	−0.69	correlation coefficient	correlation between life expectancy in the lowest income quartile and smoking across local areas, reported in the abstract of Chetty and coauthors (2016); copied from it and not computed in this build	local areas in the Health Inequality Project's analysis of life expectancy in the lowest income quartile	life expectancy 2001 to 2014; area measures as in the paper			as in the paper	Published estimates from cited studies	A published estimate for the local areas the paper analyzes, not a result of this build.
corr_adi	−0.67	correlation coefficient	correlation across counties of expected age at death at 40 (average of the women's and men's estimates, adjusted to the national racial composition) with the county Area Deprivation Index, population-weighted, bootstrap interval over states	counties in the Health Inequality Project file with the measure; poorest quartile of national household income	expected age at death 2001 to 2014; ADI 2023, mean of tract ranks weighted by ACS 2019-2023 population	95% CI −0.74 to −0.51	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
corr_adi_rich	−0.22	correlation coefficient	correlation across counties of expected age at death at 40 (average of the women's and men's estimates, adjusted to the national racial composition) with the county Area Deprivation Index, population-weighted, bootstrap interval over states	counties in the Health Inequality Project file with the measure; richest quartile of national household income	expected age at death 2001 to 2014; ADI 2023, mean of tract ranks weighted by ACS 2019-2023 population	95% CI −0.43 to −0.07	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
corr_adi_unw	−0.44	correlation coefficient	correlation across counties of expected age at death at 40 (average of the women's and men's estimates, adjusted to the national racial composition) with the county Area Deprivation Index, each county once, bootstrap interval over states	counties in the Health Inequality Project file with the measure; poorest quartile of national household income	expected age at death 2001 to 2014; ADI 2023, mean of tract ranks weighted by ACS 2019-2023 population	95% CI −0.53 to −0.34	1,559 counties	none (each county counts once)	Health Inequality Project
corr_college	+0.32	correlation coefficient	correlation across counties of expected age at death at 40 (average of the women's and men's estimates, adjusted to the national racial composition) with the share of adults with some college, population-weighted, bootstrap interval over states	counties in the Health Inequality Project file with the measure; poorest quartile of national household income	expected age at death 2001 to 2014; ACS 2018-2022	95% CI 0.25 to 0.40	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
corr_inactive_rich	−0.50	correlation coefficient	correlation across counties of expected age at death at 40 (average of the women's and men's estimates, adjusted to the national racial composition) with the share of adults with no leisure-time physical activity, population-weighted, bootstrap interval over states	counties in the Health Inequality Project file with the measure; richest quartile of national household income	expected age at death 2001 to 2014; BRFSS 2021 as modeled by County Health Rankings 2024	95% CI −0.60 to −0.41	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
corr_income	+0.48	correlation coefficient	correlation across counties of expected age at death at 40 (average of the women's and men's estimates, adjusted to the national racial composition) with median household income, population-weighted, bootstrap interval over states	counties in the Health Inequality Project file with the measure; poorest quartile of national household income	expected age at death 2001 to 2014; income from SAIPE 2022	95% CI 0.38 to 0.55	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
corr_obese	−0.64	correlation coefficient	correlation across counties of expected age at death at 40 (average of the women's and men's estimates, adjusted to the national racial composition) with the share of adults with obesity, population-weighted, bootstrap interval over states	counties in the Health Inequality Project file with the measure; poorest quartile of national household income	expected age at death 2001 to 2014; obesity from BRFSS 2021 as modeled by County Health Rankings 2024	95% CI −0.71 to −0.51	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
corr_obese_unw	−0.45	correlation coefficient	correlation across counties of expected age at death at 40 (average of the women's and men's estimates, adjusted to the national racial composition) with the share of adults with obesity, each county once, bootstrap interval over states	counties in the Health Inequality Project file with the measure; poorest quartile of national household income	expected age at death 2001 to 2014; obesity from BRFSS 2021 as modeled by County Health Rankings 2024	95% CI −0.54 to −0.34	1,559 counties	none (each county counts once)	Health Inequality Project
corr_pcp	+0.28	correlation coefficient	correlation across counties of expected age at death at 40 (average of the women's and men's estimates, adjusted to the national racial composition) with primary care physicians per 100,000 residents, population-weighted, bootstrap interval over states	counties in the Health Inequality Project file with the measure; poorest quartile of national household income	expected age at death 2001 to 2014; AMA and Area Health Resources File 2021	95% CI 0.20 to 0.35	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
corr_smoke	−0.58	correlation coefficient	correlation across counties of expected age at death at 40 (average of the women's and men's estimates, adjusted to the national racial composition) with the share of adults who smoke, population-weighted, bootstrap interval over states	counties in the Health Inequality Project file with the measure; poorest quartile of national household income	expected age at death 2001 to 2014; smoking from BRFSS 2021 as modeled by County Health Rankings 2024	95% CI −0.67 to −0.45	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
corr_smoke_unw	−0.34	correlation coefficient	correlation across counties of expected age at death at 40 (average of the women's and men's estimates, adjusted to the national racial composition) with the share of adults who smoke, each county once, bootstrap interval over states	counties in the Health Inequality Project file with the measure; poorest quartile of national household income	expected age at death 2001 to 2014; smoking from BRFSS 2021 as modeled by County Health Rankings 2024	95% CI −0.44 to −0.24	1,559 counties	none (each county counts once)	Health Inequality Project
corr_uninsured	−0.15	correlation coefficient	correlation across counties of expected age at death at 40 (average of the women's and men's estimates, adjusted to the national racial composition) with the share of people under 65 without health insurance, population-weighted, bootstrap interval over states	counties in the Health Inequality Project file with the measure; poorest quartile of national household income	expected age at death 2001 to 2014; SAHIE 2021	95% CI −0.28 to 0.06	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
corr_uninsured_rich	−0.27	correlation coefficient	correlation across counties of expected age at death at 40 (average of the women's and men's estimates, adjusted to the national racial composition) with the share of people under 65 without health insurance, population-weighted, bootstrap interval over states	counties in the Health Inequality Project file with the measure; richest quartile of national household income	expected age at death 2001 to 2014; SAHIE 2021	95% CI −0.37 to −0.18	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
corr_uninsured_unw	−0.16	correlation coefficient	correlation across counties of expected age at death at 40 (average of the women's and men's estimates, adjusted to the national racial composition) with the share of people under 65 without health insurance, each county once, bootstrap interval over states	counties in the Health Inequality Project file with the measure; poorest quartile of national household income	expected age at death 2001 to 2014; SAHIE 2021	95% CI −0.29 to 0.01	1,559 counties	none (each county counts once)	Health Inequality Project
dis_age_diff	1.8	percentage points of adult disability prevalence, tenth of tracts with the most residents aged 65 and over minus the tenth with the fewest	difference of two adult-population-weighted means (tenths of tracts by age share), bootstrap interval over counties (shared draws)	adults aged 18 and over in tracts with a PLACES disability estimate, an ADI rank and an ACS age share	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	95% CI 0.9 to 2.7	82,779 tracts	adult population of the tract (PLACES)	CDC PLACES
dis_age_hi	32.3%	percent of adults with any disability	mean of tract prevalence, weighted by adult population, bootstrap interval over counties (tenths hold equal numbers of tracts)	adults in the tenth of tracts with the most residents aged 65 and over	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	95% CI 31.8% to 32.7%	8,286 tracts	adult population of the tract (PLACES)	CDC PLACES
dis_age_lo	30.5%	percent of adults with any disability	mean of tract prevalence, weighted by adult population, bootstrap interval over counties (tenths hold equal numbers of tracts)	adults in the tenth of tracts with the fewest residents aged 65 and over	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	95% CI 29.6% to 31.3%	8,275 tracts	adult population of the tract (PLACES)	CDC PLACES
dis_d1	23.3%	percent of adults with any disability	mean of tract prevalence (crude, modeled), weighted by adult population, bootstrap interval over counties	adults in the least deprived tenth of tracts by ADI national rank	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	95% CI 22.3% to 24.1%	8,274 tracts	adult population of the tract (PLACES)	CDC PLACES	PLACES models these values from survey responses and census inputs that overlap the ADI, so part of the gradient is built in.
dis_d10	42.9%	percent of adults with any disability	mean of tract prevalence (crude, modeled), weighted by adult population, bootstrap interval over counties	adults in the most deprived tenth of tracts by ADI national rank	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	95% CI 42.5% to 43.2%	8,213 tracts	adult population of the tract (PLACES)	CDC PLACES	PLACES models these values from survey responses and census inputs that overlap the ADI, so part of the gradient is built in.
dis_q1	7.2%	percent of OASDI beneficiaries who are disabled workers	share of the fifth's beneficiaries, pooled over its ZIP codes, bootstrap interval over counties	OASDI beneficiaries in the least deprived fifth of ZIP codes by ADI national rank	December 2024	95% CI 6.9% to 7.5%	6,363 ZIP codes	beneficiaries (each ZIP code counts by its beneficiary count)	SSA beneficiaries by ZIP code	Disabled-worker benefits become retired-worker benefits at full retirement age, so former disabled workers are counted as retired workers after it.
dis_q5	16.8%	percent of OASDI beneficiaries who are disabled workers	share of the fifth's beneficiaries, pooled over its ZIP codes, bootstrap interval over counties	OASDI beneficiaries in the most deprived fifth of ZIP codes by ADI national rank	December 2024	95% CI 16.4% to 17.3%	6,363 ZIP codes	beneficiaries (each ZIP code counts by its beneficiary count)	SSA beneficiaries by ZIP code	Disabled-worker benefits become retired-worker benefits at full retirement age, so former disabled workers are counted as retired workers after it.
dis_ratio	1.8	ratio of disability prevalence in the most deprived tenth of tracts to that in the least deprived tenth	ratio of two adult-population-weighted means, bootstrap interval over counties (shared draws)	adults aged 18 and over in tracts with a PLACES disability estimate, an ADI rank and an ACS age share	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	95% CI 1.8 to 1.9	82,779 tracts	adult population of the tract (PLACES)	CDC PLACES
em_diff	−$430	dollars per fee-for-service beneficiary per year, most deprived fifth minus least deprived fifth, payments for evaluation and management visits	difference of two fee-for-service-beneficiary-weighted means of county payments per capita, bootstrap interval over states (shared draws)	fee-for-service beneficiaries in counties with every shown service line reported	2024	95% CI −$543 to −$296	2,867 counties	fee-for-service beneficiaries	Medicare Geographic Variation
em_drop	32%	percent lower payments for evaluation and management visits per beneficiary in the most deprived fifth of counties than in the least deprived fifth	one minus the ratio of the most deprived fifth's weighted mean to the least deprived fifth's, bootstrap interval over states (shared draws)	fee-for-service beneficiaries in counties with every shown service line reported	2024	95% CI 24% to 39%	2,867 counties	fee-for-service beneficiaries	Medicare Geographic Variation
em_q1	$1,333	dollars per fee-for-service beneficiary per year, price-standardized payments for evaluation and management visits	mean of county payments per capita, weighted by fee-for-service beneficiaries, bootstrap interval over states	fee-for-service beneficiaries in the least deprived fifth of counties by county ADI, counties with every shown service line reported	2024	95% CI $1,218 to $1,426	605 counties	fee-for-service beneficiaries	Medicare Geographic Variation
em_q5	$903	dollars per fee-for-service beneficiary per year, price-standardized payments for evaluation and management visits	mean of county payments per capita, weighted by fee-for-service beneficiaries, bootstrap interval over states	fee-for-service beneficiaries in the most deprived fifth of counties by county ADI, counties with every shown service line reported	2024	95% CI $831 to $967	541 counties	fee-for-service beneficiaries	Medicare Geographic Variation
er_q1	571	emergency department visits per 1,000 fee-for-service beneficiaries per year	mean of county rates, weighted by fee-for-service beneficiaries, bootstrap interval over states	fee-for-service beneficiaries in the least deprived fifth of counties by county ADI	2024	95% CI 556 to 584	625 counties	fee-for-service beneficiaries	Medicare Geographic Variation
er_q5	677	emergency department visits per 1,000 fee-for-service beneficiaries per year	mean of county rates, weighted by fee-for-service beneficiaries, bootstrap interval over states	fee-for-service beneficiaries in the most deprived fifth of counties by county ADI	2024	95% CI 656 to 694	624 counties	fee-for-service beneficiaries	Medicare Geographic Variation
er_r	+0.37	correlation coefficient	correlation of the county emergency department visit rate with the county ADI, weighted by fee-for-service beneficiaries, bootstrap interval over states	fee-for-service (Original Medicare) beneficiaries in counties with a standardized payment and an ADI rank	2024	95% CI 0.26 to 0.47	3,128 counties	fee-for-service beneficiaries	Medicare Geographic Variation
hh_diff	$224	dollars per fee-for-service beneficiary per year, most deprived fifth minus least deprived fifth, payments for home health and hospice	difference of two fee-for-service-beneficiary-weighted means of county payments per capita, bootstrap interval over states (shared draws)	fee-for-service beneficiaries in counties with every shown service line reported	2024	95% CI −$56 to $511	2,867 counties	fee-for-service beneficiaries	Medicare Geographic Variation
hip_age	40	years of age	age at which expected age at death is measured (a definition)	people whose expected age at death the Project estimates	2001 to 2014			none (definition)	Health Inequality Project
hip_median_pop	69,380	residents	median county population in the County Health Rankings 2024 release (a Census Bureau estimate for 2022) among the counties in the file	counties in the Health Inequality Project file	2022 estimate in the County Health Rankings 2024 release		1,559 counties	none (median over counties)	County Health Rankings
hip_min_pop	15,304	residents	smallest county population in the County Health Rankings 2024 release (a Census Bureau estimate for 2022) among the counties in the file	the smallest county in the Health Inequality Project file	2022 estimate in the County Health Rankings 2024 release			none (one county)	County Health Rankings
income_gap	6.7	years of expected age at death for people who reach age 40, richest quartile minus poorest	difference of two county-population-weighted means (average of the women's and men's estimates, adjusted to the national racial composition), bootstrap interval over states (shared draws)	residents who reach age 40 in the counties of the Health Inequality Project file	2001 to 2014	95% CI 6.3 to 7.2	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
ip_diff	$134	dollars per fee-for-service beneficiary per year, most deprived fifth minus least deprived fifth, payments for inpatient hospital stays	difference of two fee-for-service-beneficiary-weighted means of county payments per capita, bootstrap interval over states (shared draws)	fee-for-service beneficiaries in counties with every shown service line reported	2024	95% CI −$12 to $315	2,867 counties	fee-for-service beneficiaries	Medicare Geographic Variation
le_r_adi	−0.82	correlation coefficient	correlation of county life expectancy at birth with the county ADI, weighted by fee-for-service beneficiaries, bootstrap interval over states	fee-for-service beneficiaries in counties with a standardized payment, an ADI rank and a County Health Rankings life expectancy (Connecticut left out)	payments 2024; life expectancy for deaths in 2019 to 2021	95% CI −0.85 to −0.77	3,057 counties	fee-for-service beneficiaries	County Health Rankings
le_r_spend	−0.07	correlation coefficient	correlation of county price-standardized payments per capita with county life expectancy at birth, weighted by fee-for-service beneficiaries, bootstrap interval over states	fee-for-service beneficiaries in counties with a standardized payment, an ADI rank and a County Health Rankings life expectancy (Connecticut left out)	payments 2024; life expectancy for deaths in 2019 to 2021	95% CI −0.27 to 0.05	3,057 counties	fee-for-service beneficiaries	County Health Rankings
le_r_spend_unw	−0.35	correlation coefficient	correlation of county price-standardized payments per capita with county life expectancy at birth, each county counted once, bootstrap interval over states	fee-for-service beneficiaries in counties with a standardized payment, an ADI rank and a County Health Rankings life expectancy (Connecticut left out)	payments 2024; life expectancy for deaths in 2019 to 2021	95% CI −0.43 to −0.25	3,057 counties	none (each county counts once)	County Health Rankings
le_slope_1k	−0.12	years of life expectancy at birth per 1,000 dollars of price-standardized payments per beneficiary	beneficiary-weighted least-squares slope of county life expectancy on county payments per capita, bootstrap interval over states	fee-for-service beneficiaries in counties with a standardized payment, an ADI rank and a County Health Rankings life expectancy (Connecticut left out)	payments 2024; life expectancy for deaths in 2019 to 2021	95% CI −0.51 to 0.08	3,057 counties	fee-for-service beneficiaries	County Health Rankings
le_slope_ctrl	−0.17	years of life expectancy at birth per 1,000 dollars of price-standardized payments per beneficiary, holding the county ADI fixed	coefficient on payments in a least-squares regression of county life expectancy on payments and the county ADI, weighted by fee-for-service beneficiaries, errors clustered on state	fee-for-service beneficiaries in counties with a standardized payment, an ADI rank and a County Health Rankings life expectancy (Connecticut left out)	payments 2024; life expectancy for deaths in 2019 to 2021	95% CI −0.33 to −0.01	3,057 counties	fee-for-service beneficiaries	County Health Rankings
le_slope_ctrl_unw	−0.28	years of life expectancy at birth per 1,000 dollars of price-standardized payments per beneficiary, holding the county ADI fixed	coefficient on payments in a least-squares regression of county life expectancy on payments and the county ADI, each county counted once, errors clustered on state	fee-for-service beneficiaries in counties with a standardized payment, an ADI rank and a County Health Rankings life expectancy (Connecticut left out)	payments 2024; life expectancy for deaths in 2019 to 2021	95% CI −0.40 to −0.16	3,057 counties	none (each county counts once)	County Health Rankings
ma_share	54.5%	percent of beneficiaries with Parts A and B who are in Medicare Advantage	Medicare Advantage beneficiaries divided by Medicare Advantage plus Original Medicare beneficiaries	beneficiaries with Parts A and B in the counties counted	2024			none (full count)	Medicare Geographic Variation
medicare_age	65	years of age	age at which eligibility for Medicare begins (a definition)	people who become eligible for Medicare through age	2024			none (definition)	Medicare Geographic Variation
min_retired	50	retired workers	minimum number of retired workers for a ZIP code to enter the benefit analysis	ZIP codes in the benefit analysis	December 2024			none (inclusion rule)	SSA beneficiaries by ZIP code
n_belt	1,838	counties	count of counties	counties with at least 5,000 OASDI beneficiaries in the ZIP codes the atlas assigns to them	December 2024			none (full count)	SSA beneficiaries by ZIP code	A ZIP code is counted in one county, the one the atlas assigns to it, so a county total is approximate where ZIP codes cross county lines.
n_benes_ssa	65.9 million	OASDI beneficiaries	sum of beneficiary counts (SSA controlled-rounded counts), ZIP codes of the same state line summed	OASDI beneficiaries living in the ZIP codes counted	December 2024			none (full count)	SSA beneficiaries by ZIP code
n_big_cty	283	counties	count of counties	counties in the Health Inequality Project file with at least 250,000 residents in the County Health Rankings 2024 release	2001 to 2014			none (full count)	Health Inequality Project
n_covariates	15	county measures	number of County Health Rankings measures in the correlation figure	county measures correlated with expected age at death	2018 to 2023			none (count)	County Health Rankings
n_cty_med	3,128	counties	count of counties	counties and county equivalents (Connecticut by planning region) with a standardized payment, fee-for-service beneficiaries and an ADI rank	2024			none (full count)	Medicare Geographic Variation
n_ffs	27.6 million	fee-for-service beneficiaries	sum of Original Medicare beneficiaries (the denominator of the per-capita payments)	beneficiaries enrolled in Original Medicare with Parts A and B in the counties counted	2024			none (full count)	Medicare Geographic Variation
n_hip	1,559	counties	count of counties	counties in the Health Inequality Project file (the larger counties; Connecticut by legacy county)	2001 to 2014			none (full count)	Health Inequality Project
n_le_cty	3,057	counties	count of counties	counties with a standardized payment, an ADI rank and a County Health Rankings life expectancy (Connecticut left out)	payments 2024; life expectancy for deaths in 2019 to 2021			none (full count)	County Health Rankings
n_map_counties	1,559	counties	count of sprite counties with an estimate	counties drawn with a value on the county map	2001 to 2014			none (full count)	Health Inequality Project
n_outside_age	398	tracts	count of tracts outside the plotted range	tracts outside the plotted range of the age-structure scatter plot	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023			none (full count)	CDC PLACES
n_outside_ben	102	ZIP codes	count of ZIP codes outside the plotted range	ZIP codes outside the plotted range of the benefit scatter plot	December 2024			none (full count)	SSA beneficiaries by ZIP code
n_outside_le	34	counties	count of counties outside the plotted range	counties outside the plotted range of the payments-and-life-expectancy scatter plot	payments 2024; life expectancy for deaths in 2019 to 2021			none (full count)	County Health Rankings
n_rich_higher	1,558	counties	count of counties (average of the women's and men's estimates, adjusted to the national racial composition)	counties in the Health Inequality Project file in which the richest quartile's expected age at death exceeds the poorest quartile's	2001 to 2014		1,559 counties	none (full count)	Health Inequality Project
n_sample_age	2,000	tracts	size of a random sample drawn with a fixed seed from the tracts inside the plotted range	tracts drawn at random for the scatter plot	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023		82,779 tracts	none (sample size)	CDC PLACES
n_sample_ben	2,000	ZIP codes	size of a random sample drawn with a fixed seed from the ZIP codes inside the plotted range	ZIP codes drawn at random for the scatter plot	December 2024		28,547 ZIP codes	none (sample size)	SSA beneficiaries by ZIP code
n_tracts_dis	82,779	tracts	count of tracts	2020 census tracts with a PLACES any-disability estimate, an ADI rank and an ACS 2019-2023 share aged 65 and over	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023			none (full count)	CDC PLACES
n_zips_ben	28,547	ZIP codes	count of ZIP codes	ZIP codes with at least 50 retired workers, a median household income and an ADI rank	December 2024			none (full count)	SSA beneficiaries by ZIP code
n_zips_ssa	31,815	ZIP codes	count of ZIP codes	ZIP codes in the 50 states and DC with OASDI beneficiaries that match a ZCTA with an ADI rank, a population and a county	December 2024			none (full count)	SSA beneficiaries by ZIP code
op_diff	$410	dollars per fee-for-service beneficiary per year, most deprived fifth minus least deprived fifth, payments for hospital outpatient departments and surgery centers	difference of two fee-for-service-beneficiary-weighted means of county payments per capita, bootstrap interval over states (shared draws)	fee-for-service beneficiaries in counties with every shown service line reported	2024	95% CI $206 to $601	2,867 counties	fee-for-service beneficiaries	Medicare Geographic Variation
oth_diff	$480	dollars per fee-for-service beneficiary per year, most deprived fifth minus least deprived fifth, payments for all other services (the total minus the lines shown)	difference of two fee-for-service-beneficiary-weighted means of county payments per capita, bootstrap interval over states (shared draws)	fee-for-service beneficiaries in counties with every shown service line reported	2024	95% CI $243 to $736	2,867 counties	fee-for-service beneficiaries	Medicare Geographic Variation
pen_q1	41.7%	percent of the sum of taxable pensions and annuities and annualized OASDI benefits	pooled dollars of taxable pensions and annuities (IRS line for pensions and annuities in adjusted gross income) divided by those dollars plus 12 times the December 2024 monthly OASDI benefits, bootstrap interval over counties	ZIP codes in the least deprived fifth by ADI national rank with IRS and SSA values	IRS tax year 2022 (amounts in thousands of dollars, converted); OASDI December 2024 benefits at an annual rate	95% CI 41.0% to 42.4%	5,847 ZIP codes	dollars (pooled over ZIP codes)	IRS Statistics of Income	Pensions here are private, government and military pensions and annuities reported on tax returns. The two sources cover different years and different people, so the share is a rough index.
pen_q5	28.0%	percent of the sum of taxable pensions and annuities and annualized OASDI benefits	pooled dollars of taxable pensions and annuities (IRS line for pensions and annuities in adjusted gross income) divided by those dollars plus 12 times the December 2024 monthly OASDI benefits, bootstrap interval over counties	ZIP codes in the most deprived fifth by ADI national rank with IRS and SSA values	IRS tax year 2022 (amounts in thousands of dollars, converted); OASDI December 2024 benefits at an annual rate	95% CI 27.5% to 28.4%	4,962 ZIP codes	dollars (pooled over ZIP codes)	IRS Statistics of Income	Pensions here are private, government and military pensions and annuities reported on tax returns. The two sources cover different years and different people, so the share is a rough index.
poor_mean	79.5	years, expected age at death for people who reach age 40	mean of county values (average of the women's and men's estimates, adjusted to the national racial composition), weighted by county population (County Health Rankings 2024 release, a 2022 estimate), bootstrap interval over states	residents who reach age 40 in the counties of the Health Inequality Project file in the poorest quartile of national household income	2001 to 2014	95% CI 79.1 to 79.9	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
poor_p5	77.5	years, expected age at death for people who reach age 40	5th percentile of county values (average of the women's and men's estimates, adjusted to the national racial composition), weighted by county population	poorest quartile of national household income, all counties in the file	2001 to 2014		1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
poor_p95	81.8	years, expected age at death for people who reach age 40	95th percentile of county values (average of the women's and men's estimates, adjusted to the national racial composition), weighted by county population	poorest quartile of national household income, all counties in the file	2001 to 2014		1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
poor_sd	1.13	years, standard deviation of county values of expected age at death at 40 with sampling variance removed	square root of the variance of county values (average of the women's and men's estimates, adjusted to the national racial composition) minus the mean squared bootstrap standard error, each county counted once, bootstrap interval over states	poorest quartile of national household income, all counties in the file	2001 to 2014	95% CI 1.00 to 1.24	1,559 counties	none (each county counts once)	Health Inequality Project
poor_spread	4.3	years from the 5th to the 95th percentile of county expected age at death at 40	width of the 5th-to-95th percentile range of county values (average of the women's and men's estimates, adjusted to the national racial composition), weighted by county population, bootstrap interval over states	poorest quartile of national household income, all counties in the file	2001 to 2014	95% CI 3.7 to 4.9	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
poor_spread_agg	6.4	years from the 5th to the 95th percentile of county expected age at death at 40, not adjusted for race	width of the 5th-to-95th percentile range of county values (average of the women's and men's estimates, not race-adjusted), weighted by county population, bootstrap interval over states	poorest quartile of national household income, all counties in the file	2001 to 2014	95% CI 4.7 to 6.7	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
poor_spread_big	4.2	years from the 5th to the 95th percentile of county expected age at death at 40	width of the 5th-to-95th percentile range of county values (average of the women's and men's estimates, adjusted to the national racial composition), weighted by county population, bootstrap interval over states	poorest quartile of national household income, counties of at least 250,000 residents	2001 to 2014	95% CI 3.5 to 5.0	283 counties	county residents (County Health Rankings 2024)	Health Inequality Project
poor_spread_unw	4.0	years from the 5th to the 95th percentile of county expected age at death at 40	width of the 5th-to-95th percentile range of county values (average of the women's and men's estimates, adjusted to the national racial composition), each county counted once, bootstrap interval over states	poorest quartile of national household income, all counties in the file	2001 to 2014	95% CI 3.7 to 4.4	1,559 counties	none (each county counts once)	Health Inequality Project
proc_diff	−$738	dollars per fee-for-service beneficiary per year, most deprived fifth minus least deprived fifth, payments for procedures, tests, imaging and treatments	difference of two fee-for-service-beneficiary-weighted means of county payments per capita, bootstrap interval over states (shared draws)	fee-for-service beneficiaries in counties with every shown service line reported	2024	95% CI −$971 to −$475	2,867 counties	fee-for-service beneficiaries	Medicare Geographic Variation
proc_q1	$2,508	dollars per fee-for-service beneficiary per year, price-standardized payments for procedures, tests, imaging and treatments	mean of county payments per capita, weighted by fee-for-service beneficiaries, bootstrap interval over states	fee-for-service beneficiaries in the least deprived fifth of counties by county ADI, counties with every shown service line reported	2024	95% CI $2,275 to $2,723	605 counties	fee-for-service beneficiaries	Medicare Geographic Variation
proc_q5	$1,770	dollars per fee-for-service beneficiary per year, price-standardized payments for procedures, tests, imaging and treatments	mean of county payments per capita, weighted by fee-for-service beneficiaries, bootstrap interval over states	fee-for-service beneficiaries in the most deprived fifth of counties by county ADI, counties with every shown service line reported	2024	95% CI $1,635 to $1,884	541 counties	fee-for-service beneficiaries	Medicare Geographic Variation
r_ben_inc	+0.84	correlation coefficient	correlation of a ZIP code's average monthly retired-worker benefit with its median household income, weighted by ZIP-code population, bootstrap interval over counties	ZIP codes with at least 50 retired workers and a median household income	OASDI December 2024; ACS 2019-2023	95% CI 0.83 to 0.85	28,547 ZIP codes	ACS 2019-2023 ZCTA population	SSA beneficiaries by ZIP code
r_ben_inc_unw	+0.80	correlation coefficient	correlation of a ZIP code's average monthly retired-worker benefit with its median household income, each ZIP code counted once, bootstrap interval over counties	ZIP codes with at least 50 retired workers and a median household income	OASDI December 2024; ACS 2019-2023	95% CI 0.79 to 0.82	28,547 ZIP codes	none (each ZIP code counts once)	SSA beneficiaries by ZIP code
r_dis_adi	+0.69	correlation coefficient	adult-population-weighted correlation of tract disability prevalence with the ADI national rank, bootstrap interval over counties	adults aged 18 and over in tracts with a PLACES disability estimate, an ADI rank and an ACS age share	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	95% CI 0.65 to 0.73	82,779 tracts	adult population of the tract (PLACES)	CDC PLACES
r_dis_age	+0.07	correlation coefficient	adult-population-weighted correlation of tract disability prevalence with the share of residents aged 65 and over, bootstrap interval over counties	adults aged 18 and over in tracts with a PLACES disability estimate, an ADI rank and an ACS age share	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	95% CI 0.04 to 0.10	82,779 tracts	adult population of the tract (PLACES)	CDC PLACES
r_dis_zip	+0.68	correlation coefficient	correlation of a ZIP code's disabled-worker share of OASDI beneficiaries with its ADI national rank, weighted by the ZIP code area's population, bootstrap interval over counties	OASDI beneficiaries in ZIP codes in the 50 states and DC that match a ZCTA with an ADI rank, a population and a county	December 2024	95% CI 0.64 to 0.71	31,815 ZIP codes	ACS 2019-2023 ZCTA population	SSA beneficiaries by ZIP code
r_dis_zip_unw	+0.52	correlation coefficient	correlation of a ZIP code's disabled-worker share of OASDI beneficiaries with its ADI national rank, with each ZIP code counted once, bootstrap interval over counties	OASDI beneficiaries in ZIP codes in the 50 states and DC that match a ZCTA with an ADI rank, a population and a county	December 2024	95% CI 0.50 to 0.54	31,815 ZIP codes	none (each ZIP code counts once)	SSA beneficiaries by ZIP code
ratio_90_10	1.42	ratio of the 90th to the 10th percentile of county price-standardized payments per capita	beneficiary-weighted percentile ratio across counties, bootstrap interval over states	fee-for-service (Original Medicare) beneficiaries in counties with a standardized payment and an ADI rank	2024	95% CI 1.34 to 1.49	3,128 counties	fee-for-service beneficiaries	Medicare Geographic Variation
ret_q1	80.5%	percent of OASDI beneficiaries who are retired workers	share of the fifth's beneficiaries, pooled over its ZIP codes, bootstrap interval over counties	OASDI beneficiaries in the least deprived fifth of ZIP codes by ADI national rank	December 2024	95% CI 79.9% to 81.1%	6,363 ZIP codes	beneficiaries (each ZIP code counts by its beneficiary count)	SSA beneficiaries by ZIP code
ret_q5	65.9%	percent of OASDI beneficiaries who are retired workers	share of the fifth's beneficiaries, pooled over its ZIP codes, bootstrap interval over counties	OASDI beneficiaries in the most deprived fifth of ZIP codes by ADI national rank	December 2024	95% CI 65.3% to 66.4%	6,363 ZIP codes	beneficiaries (each ZIP code counts by its beneficiary count)	SSA beneficiaries by ZIP code
rich_mean	86.3	years, expected age at death for people who reach age 40	mean of county values (average of the women's and men's estimates, adjusted to the national racial composition), weighted by county population (County Health Rankings 2024 release, a 2022 estimate), bootstrap interval over states	residents who reach age 40 in the counties of the Health Inequality Project file in the richest quartile of national household income	2001 to 2014	95% CI 86.1 to 86.4	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
rich_p5	84.7	years, expected age at death for people who reach age 40	5th percentile of county values (average of the women's and men's estimates, adjusted to the national racial composition), weighted by county population	richest quartile of national household income, all counties in the file	2001 to 2014		1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
rich_p95	87.7	years, expected age at death for people who reach age 40	95th percentile of county values (average of the women's and men's estimates, adjusted to the national racial composition), weighted by county population	richest quartile of national household income, all counties in the file	2001 to 2014		1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
rich_sd	0.91	years, standard deviation of county values of expected age at death at 40 with sampling variance removed	square root of the variance of county values (average of the women's and men's estimates, adjusted to the national racial composition) minus the mean squared bootstrap standard error, each county counted once, bootstrap interval over states	richest quartile of national household income, all counties in the file	2001 to 2014	95% CI 0.77 to 1.02	1,559 counties	none (each county counts once)	Health Inequality Project
rich_spread	3.0	years from the 5th to the 95th percentile of county expected age at death at 40	width of the 5th-to-95th percentile range of county values (average of the women's and men's estimates, adjusted to the national racial composition), weighted by county population, bootstrap interval over states	richest quartile of national household income, all counties in the file	2001 to 2014	95% CI 2.7 to 3.6	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
rich_spread_agg	3.0	years from the 5th to the 95th percentile of county expected age at death at 40, not adjusted for race	width of the 5th-to-95th percentile range of county values (average of the women's and men's estimates, not race-adjusted), weighted by county population, bootstrap interval over states	richest quartile of national household income, all counties in the file	2001 to 2014	95% CI 2.7 to 3.4	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
rich_spread_big	2.6	years from the 5th to the 95th percentile of county expected age at death at 40	width of the 5th-to-95th percentile range of county values (average of the women's and men's estimates, adjusted to the national racial composition), weighted by county population, bootstrap interval over states	richest quartile of national household income, counties of at least 250,000 residents	2001 to 2014	95% CI 2.3 to 3.4	283 counties	county residents (County Health Rankings 2024)	Health Inequality Project
rich_spread_unw	4.3	years from the 5th to the 95th percentile of county expected age at death at 40	width of the 5th-to-95th percentile range of county values (average of the women's and men's estimates, adjusted to the national racial composition), each county counted once, bootstrap interval over states	richest quartile of national household income, all counties in the file	2001 to 2014	95% CI 3.9 to 4.6	1,559 counties	none (each county counts once)	Health Inequality Project
sc_q1	7.5%	percent of OASDI beneficiaries who are spouses and children	share of the fifth's beneficiaries, pooled over its ZIP codes, bootstrap interval over counties	OASDI beneficiaries in the least deprived fifth of ZIP codes by ADI national rank	December 2024	95% CI 7.2% to 7.8%	6,363 ZIP codes	beneficiaries (each ZIP code counts by its beneficiary count)	SSA beneficiaries by ZIP code
sc_q5	10.7%	percent of OASDI beneficiaries who are spouses and children	share of the fifth's beneficiaries, pooled over its ZIP codes, bootstrap interval over counties	OASDI beneficiaries in the most deprived fifth of ZIP codes by ADI national rank	December 2024	95% CI 10.4% to 10.9%	6,363 ZIP codes	beneficiaries (each ZIP code counts by its beneficiary count)	SSA beneficiaries by ZIP code
sd_diff	0.22	years, standard deviation for the poorest quartile minus that for the richest, sampling variance removed	difference of the two standard deviations of county values (average of the women's and men's estimates, adjusted to the national racial composition) after removing the mean squared bootstrap standard error, each county counted once, bootstrap interval over states (shared draws)	both quartiles, all counties in the file	2001 to 2014	95% CI 0.08 to 0.38	1,559 counties	none (each county counts once)	Health Inequality Project
se_poor	0.5	years, bootstrap standard error of a county's expected age at death	mean over counties of the Project's bootstrap standard errors (the women's and men's combined as independent), race-adjusted	poorest quartile of national household income, all counties in the file	2001 to 2014		1,559 counties	none (each county counts once)	Health Inequality Project
se_rich	0.9	years, bootstrap standard error of a county's expected age at death	mean over counties of the Project's bootstrap standard errors (the women's and men's combined as independent), race-adjusted	richest quartile of national household income, all counties in the file	2001 to 2014		1,559 counties	none (each county counts once)	Health Inequality Project
slope_adi	2.0	percentage points of adult disability prevalence per ten points of ADI national rank	adult-population-weighted least-squares slope of tract disability prevalence on the ADI rank, errors clustered on county	adults aged 18 and over in tracts with a PLACES disability estimate, an ADI rank and an ACS age share	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	95% CI 1.8 to 2.1	82,779 tracts	adult population of the tract (PLACES)	CDC PLACES
slope_adi_ctrl	2.0	percentage points of adult disability prevalence per ten points of ADI national rank, holding the share aged 65 and over fixed	adult-population-weighted least-squares slope on the ADI rank in a regression that also includes the tract's share aged 65 and over, errors clustered on county	adults aged 18 and over in tracts with a PLACES disability estimate, an ADI rank and an ACS age share	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	95% CI 1.8 to 2.1	82,779 tracts	adult population of the tract (PLACES)	CDC PLACES
small_ben_q1	3.1%	percent of the fifth's fee-for-service beneficiaries who live in counties below the size cutoff	beneficiaries in counties with fewer than the cutoff divided by all beneficiaries of the fifth	fee-for-service beneficiaries in the least deprived fifth of counties by county ADI	2024		625 counties	fee-for-service beneficiaries	Medicare Geographic Variation
small_ben_q5	87.3%	percent of the fifth's fee-for-service beneficiaries who live in counties below the size cutoff	beneficiaries in counties with fewer than the cutoff divided by all beneficiaries of the fifth	fee-for-service beneficiaries in the most deprived fifth of counties by county ADI	2024		624 counties	fee-for-service beneficiaries	Medicare Geographic Variation
small_cut	5,000	fee-for-service beneficiaries	county size below which a county is called small	counties in the size check of the spending comparison	2024			none (cutoff)	Medicare Geographic Variation
small_share_q5	97%	percent of counties in the most deprived fifth that are small	share of counties with fewer than the cutoff of fee-for-service beneficiaries	counties in the most deprived fifth by county ADI	2024		624 counties	none (each county counts once)	Medicare Geographic Variation
snf_diff	$437	dollars per fee-for-service beneficiary per year, most deprived fifth minus least deprived fifth, payments for skilled nursing facilities	difference of two fee-for-service-beneficiary-weighted means of county payments per capita, bootstrap interval over states (shared draws)	fee-for-service beneficiaries in counties with every shown service line reported	2024	95% CI $214 to $653	2,867 counties	fee-for-service beneficiaries	Medicare Geographic Variation
snf_q1	$865	dollars per fee-for-service beneficiary per year, price-standardized payments for skilled nursing facilities	mean of county payments per capita, weighted by fee-for-service beneficiaries, bootstrap interval over states	fee-for-service beneficiaries in the least deprived fifth of counties by county ADI, counties with every shown service line reported	2024	95% CI $712 to $986	605 counties	fee-for-service beneficiaries	Medicare Geographic Variation
snf_q5	$1,302	dollars per fee-for-service beneficiary per year, price-standardized payments for skilled nursing facilities	mean of county payments per capita, weighted by fee-for-service beneficiaries, bootstrap interval over states	fee-for-service beneficiaries in the most deprived fifth of counties by county ADI, counties with every shown service line reported	2024	95% CI $1,122 to $1,462	541 counties	fee-for-service beneficiaries	Medicare Geographic Variation
spend_diff	$496	dollars per fee-for-service beneficiary per year	mean in the most deprived fifth of counties minus mean in the least deprived fifth, weighted by fee-for-service beneficiaries, bootstrap interval over states (shared draws)	fee-for-service (Original Medicare) beneficiaries in counties with a standardized payment and an ADI rank	2024	95% CI −$290 to $1406	3,128 counties	fee-for-service beneficiaries	Medicare Geographic Variation
spend_large_q1	$12,736	dollars per fee-for-service beneficiary per year, price-standardized	mean of county price-standardized payments per capita, weighted by fee-for-service beneficiaries, bootstrap interval over states	counties with at least 5,000 fee-for-service beneficiaries, least deprived fifth by county ADI	2024	95% CI $12,046 to $13,250	444 counties	fee-for-service beneficiaries	Medicare Geographic Variation
spend_large_q5	$12,359	dollars per fee-for-service beneficiary per year, price-standardized	mean of county price-standardized payments per capita, weighted by fee-for-service beneficiaries, bootstrap interval over states	counties with at least 5,000 fee-for-service beneficiaries, most deprived fifth by county ADI	2024	95% CI $11,830 to $12,916	21 counties	fee-for-service beneficiaries	Medicare Geographic Variation
spend_mean	$12,585	dollars per fee-for-service beneficiary per year, price-standardized	mean of county price-standardized Part A and Part B payments per capita, weighted by fee-for-service beneficiaries, bootstrap interval over states	fee-for-service (Original Medicare) beneficiaries in counties with a standardized payment and an ADI rank	2024	95% CI $12,125 to $12,987	3,128 counties	fee-for-service beneficiaries	Medicare Geographic Variation
spend_p10	$10,433	dollars per fee-for-service beneficiary per year, price-standardized	10th percentile of county price-standardized payments per capita, weighted by fee-for-service beneficiaries	fee-for-service (Original Medicare) beneficiaries in counties with a standardized payment and an ADI rank	2024		3,128 counties	fee-for-service beneficiaries	Medicare Geographic Variation
spend_p90	$14,770	dollars per fee-for-service beneficiary per year, price-standardized	90th percentile of county price-standardized payments per capita, weighted by fee-for-service beneficiaries	fee-for-service (Original Medicare) beneficiaries in counties with a standardized payment and an ADI rank	2024		3,128 counties	fee-for-service beneficiaries	Medicare Geographic Variation
spend_q1	$12,680	dollars per fee-for-service beneficiary per year, price-standardized	mean of county price-standardized payments per capita, weighted by fee-for-service beneficiaries, bootstrap interval over states (fifths hold equal numbers of counties)	fee-for-service beneficiaries in the least deprived fifth of counties by county ADI	2024	95% CI $11,997 to $13,194	625 counties	fee-for-service beneficiaries	Medicare Geographic Variation
spend_q5	$13,176	dollars per fee-for-service beneficiary per year, price-standardized	mean of county price-standardized payments per capita, weighted by fee-for-service beneficiaries, bootstrap interval over states (fifths hold equal numbers of counties)	fee-for-service beneficiaries in the most deprived fifth of counties by county ADI	2024	95% CI $12,517 to $13,785	624 counties	fee-for-service beneficiaries	Medicare Geographic Variation
spend_r	−0.04	correlation coefficient	correlation of county price-standardized payments per capita with the county ADI, weighted by fee-for-service beneficiaries, bootstrap interval over states	fee-for-service (Original Medicare) beneficiaries in counties with a standardized payment and an ADI rank	2024	95% CI −0.19 to 0.21	3,128 counties	fee-for-service beneficiaries	Medicare Geographic Variation
spend_r_unw	+0.30	correlation coefficient	correlation of county price-standardized payments per capita with the county ADI, each county counted once, bootstrap interval over states	fee-for-service (Original Medicare) beneficiaries in counties with a standardized payment and an ADI rank	2024	95% CI 0.20 to 0.39	3,128 counties	none (each county counts once)	Medicare Geographic Variation
spend_small_q1	$10,893	dollars per fee-for-service beneficiary per year, price-standardized	mean of county price-standardized payments per capita, weighted by fee-for-service beneficiaries, bootstrap interval over states	counties with fewer than 5,000 fee-for-service beneficiaries, least deprived fifth by county ADI	2024	95% CI $10,526 to $11,270	181 counties	fee-for-service beneficiaries	Medicare Geographic Variation
spend_small_q5	$13,295	dollars per fee-for-service beneficiary per year, price-standardized	mean of county price-standardized payments per capita, weighted by fee-for-service beneficiaries, bootstrap interval over states	counties with fewer than 5,000 fee-for-service beneficiaries, most deprived fifth by county ADI	2024	95% CI $12,601 to $13,903	603 counties	fee-for-service beneficiaries	Medicare Geographic Variation
spread_diff	1.3	years, width for the poorest quartile minus width for the richest	difference of the two 5th-to-95th percentile widths (average of the women's and men's estimates, adjusted to the national racial composition), weighted by county population, bootstrap interval over states (shared draws)	both quartiles, all counties in the file	2001 to 2014	95% CI 0.3 to 1.9	1,559 counties	county residents (County Health Rankings 2024)	Health Inequality Project
spread_diff_big	1.6	years, width for the poorest quartile minus width for the richest	difference of the two 5th-to-95th percentile widths (average of the women's and men's estimates, adjusted to the national racial composition), weighted by county population, bootstrap interval over states (shared draws)	both quartiles, counties of at least 250,000 residents	2001 to 2014	95% CI 0.7 to 2.5	283 counties	county residents (County Health Rankings 2024)	Health Inequality Project
spread_diff_unw	−0.3	years, width for the poorest quartile minus width for the richest	difference of the two 5th-to-95th percentile widths (average of the women's and men's estimates, adjusted to the national racial composition), each county counted once, bootstrap interval over states (shared draws)	both quartiles, all counties in the file	2001 to 2014	95% CI −0.7 to 0.2	1,559 counties	none (each county counts once)	Health Inequality Project
teeth_d1	6.9%	percent of adults aged 65 and over who have lost all their teeth	mean of tract prevalence (crude, modeled), weighted by the tract's estimated residents aged 65 and over, bootstrap interval over counties	adults aged 65 and over in the least deprived tenth of tracts by ADI national rank	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	95% CI 6.2% to 7.9%	8,258 tracts	residents aged 65 and over (ACS 2019-2023 share times ACS population)	CDC PLACES	PLACES models these values from survey responses and census inputs that overlap the ADI, so part of the gradient is built in.
teeth_d10	25.1%	percent of adults aged 65 and over who have lost all their teeth	mean of tract prevalence (crude, modeled), weighted by the tract's estimated residents aged 65 and over, bootstrap interval over counties	adults aged 65 and over in the most deprived tenth of tracts by ADI national rank	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	95% CI 24.7% to 25.6%	8,213 tracts	residents aged 65 and over (ACS 2019-2023 share times ACS population)	CDC PLACES	PLACES models these values from survey responses and census inputs that overlap the ADI, so part of the gradient is built in.
teeth_ratio	3.6	ratio of tooth loss in the most deprived tenth of tracts to that in the least deprived tenth	ratio of two weighted means, bootstrap interval over counties (shared draws)	adults aged 65 and over in tracts with a PLACES tooth-loss estimate, an ADI rank and an ACS age share	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	95% CI 3.2 to 4.0	82,662 tracts	residents aged 65 and over (ACS 2019-2023 share times ACS population)	CDC PLACES
us_disability	30.9%	percent of adults with any disability	mean of tract prevalence (crude, modeled) over all the tracts of the tenths pooled, weighted by adult population, bootstrap interval over counties (the draws of the tenths)	adults aged 18 and over in all the tracts of the comparison: tracts with a PLACES disability estimate, an ADI rank and an ACS age share	2024 release of CDC PLACES (BRFSS responses from 2022); ADI 2023	95% CI 30.5% to 31.3%	82,779 tracts	adult population of the tract (PLACES)	CDC PLACES
us_ed_visits	592	emergency department visits per 1,000 fee-for-service beneficiaries per year	mean of county rates over all the counties of the fifths pooled, weighted by fee-for-service beneficiaries, bootstrap interval over states (the draws of the fifths)	fee-for-service beneficiaries in all the counties of the comparison: counties with a standardized payment and an ADI rank	2024	95% CI 581 to 602	3,128 counties	fee-for-service beneficiaries	Medicare Geographic Variation
wid_q1	4.8%	percent of OASDI beneficiaries who are widows, widowers and parents	share of the fifth's beneficiaries, pooled over its ZIP codes, bootstrap interval over counties	OASDI beneficiaries in the least deprived fifth of ZIP codes by ADI national rank	December 2024	95% CI 4.7% to 4.9%	6,363 ZIP codes	beneficiaries (each ZIP code counts by its beneficiary count)	SSA beneficiaries by ZIP code
wid_q5	6.6%	percent of OASDI beneficiaries who are widows, widowers and parents	share of the fifth's beneficiaries, pooled over its ZIP codes, bootstrap interval over counties	OASDI beneficiaries in the most deprived fifth of ZIP codes by ADI national rank	December 2024	95% CI 6.5% to 6.8%	6,363 ZIP codes	beneficiaries (each ZIP code counts by its beneficiary count)	SSA beneficiaries by ZIP code

Definitions

Area Deprivation Index (ADI): A score that ranks neighborhoods by income, education, employment and housing conditions drawn from the American Community Survey. In this book a higher national percentile means a more deprived neighborhood.
Modeled estimate: A figure produced by a statistical model instead of a direct count or measurement, usually for small areas where direct data are thin, borrowing strength from surveys, neighboring areas or other data. Neighboring areas can share errors, so single extremes call for caution.
OASDI: Old-Age, Survivors and Disability Insurance, the Social Security programs that pay retirement, survivor and disability benefits.
ZCTA: ZIP Code Tabulation Area, the Census Bureau's approximation of a ZIP code as a set of census blocks. It lets census data be reported by ZIP code, though some ZIP codes have no matching ZCTA.
Price-standardized spending: Medicare spending adjusted to remove differences in local prices and payment rules, so that counties are compared on the care paid for rather than on local prices. It does not adjust for how sick the beneficiaries are.
Life expectancy at birth: The average number of years a newborn would live if death rates at every age stayed as they were in the period measured. It summarizes the death rates of a period and is not a forecast for any child.
Ecological inference: Drawing conclusions about individuals from data about places or groups. A pattern across counties need not hold for the people inside them.

Methods

This chapter compares tracts, ZIP codes and counties across tenths or fifths of the Area Deprivation Index (2023 national rank) on disability, tooth loss, Social Security beneficiaries and benefits, pensions, Medicare payments and expected age at death at 40. The sources differ in kind and period: PLACES prevalence is modeled with census and ACS inputs from BRFSS 2022 responses, the Social Security counts are for December 2024, pensions are for tax year 2022, and Medicare payments for 2024 are for Original Medicare beneficiaries with both parts. ZIP codes with no ZCTA are left out, and intervals come from a bootstrap over whole counties or states.

How disability and tooth loss are measured

Tract disability and tooth loss are CDC PLACES crude prevalence among adults (2024 release, BRFSS 2022 responses, modeled with census and ACS inputs), weighted by adult population (disability) and by estimated residents aged 65 and over (tooth loss).

Figure explained here: Figure 1

How places are ranked and grouped by deprivation

Tenths and fifths hold equal numbers of tracts, ZIP codes or counties, ranked on the Area Deprivation Index national rank (2023). A county's rank is the mean of its tracts' ranks weighted by ACS population.

Social Security counts and benefits are SSA's December 2024 ZIP code table for the 50 states and DC: ZIP codes that cross a state line are summed, benefit totals in thousands of dollars are converted to dollars, and a ZIP code is matched to the ZCTA of the same number in the project's ZCTA atlas (ZIP codes with no ZCTA are left out; Connecticut's are matched like the rest).

Pensions are taxable pensions and annuities from IRS Statistics of Income for tax year 2022 (thousands of dollars, converted), set against 12 times the December 2024 monthly benefits.

Figures explained here: Figure 2 and Figure 3

What the Medicare payments cover

Medicare payments are CMS price-standardized Part A and Part B payments per capita for Original Medicare beneficiaries with both parts, 2024; the file has one row per county, and Connecticut appears by planning region.

Counties with a blank service line are left out of the stacked bars and the last segment is the total minus the lines shown.

Figure explained here: Figure 4

How expected age at death is measured and weighted

Expected age at death at 40 is the Health Inequality Project's county estimate by national household-income quartile; the chapter uses the race-adjusted column, averaged over women and men, and weights counties by their residents in the County Health Rankings 2024 release (a Census Bureau estimate for 2022).

Figures explained here: Figure 5, Figure 6 and Figure 7

How intervals, ranges and plotted samples are computed

Intervals are 95% percentile intervals from 2,000 draws of whole clusters with replacement (seed 12345): counties for tract and ZIP code estimates and states for county estimates, computed by the same routine for means, shares, ratios, differences, correlations and slopes; the regressions use cluster-robust errors on county.

The width of the range of county values is the distance from the 5th to the 95th weighted percentile.

Scatter plots show random samples (tracts, ZIP codes) inside the plotted range with the same seed, or every county.

Four rankings of the same places

The comparison follows the book's ranking switch rule, fixed on October 28, 2026 before any of these gradients was computed. The main gradient of the chapter is recomputed under four rankings of the same places, with the outcome, period, weights, bins and intervals unchanged: the published ADI; a standardized index that applies the ADI's coefficients to its measures after standardizing each one across tracts; median household income; and the share of adults 25 and older with a bachelor's degree or more. The three alternatives come from ACS tract estimates for 2019 to 2023, the period of the ADI.

All four rankings use the same places, the 75,596 tracts that have the outcome and all four rankings, so the ADI panel can differ slightly from the chapter's main figure. Tracts enter only if they have every input of the standardized index, which leaves out tracts without a median rent, home value or mortgage cost.

A pattern counts as changed when the worse end switches sides, when the two ends differ under one ranking and not the other, or when the rank correlation of bin order and bin mean falls on the other side of 0.9 and moves by at least 0.1.

Figure explained here: Figure 8

What these data cannot show

The correlates are measured years after the deaths, and smoking and obesity are County Health Rankings' modeled estimates for all adults, not for the poorest quartile. The Project's authors found that the share of immigrants was among the strongest correlates of low-income longevity across local areas, a pattern that tract and county measures of this kind cannot separate from place itself (see Chapter 9.5, Immigrants and the gradient (https://vishalsingh.org/zipcode/immigrants-and-the-gradient; planned)). Weights matter for several results here. The Medicare correlations with deprivation and with life expectancy and the spread of the richest quartile's expected age at death all change when each county counts once, and both versions are reported.

References

Kind, Amy J. H.; Buckingham, William R. (2018). Making Neighborhood-Disadvantage Metrics Accessible: The Neighborhood Atlas. New England Journal of Medicine 378(26): 2456-2458. doi:10.1056/NEJMp1802313
Greenlund, Kurt J.; Lu, Hua; Wang, Yan; Matthews, Kevin A.; LeClercq, Jennifer M.; Lee, Benjamin; Carlson, Susan A. (2022). PLACES: Local Data for Better Health. Preventing Chronic Disease 19: 210459. doi:10.5888/pcd19.210459
Centers for Medicare & Medicaid Services (2026). Medicare Data for the Original Medicare Geographic Variation Public Use File: A Methodological Overview (May 2026 update). CMS Office of Enterprise Data and Analytics. data.cms.gov/sites/default/files/2026-05/Original%20Medicare%20Geographic%20Variation%20Public%20Use%20File%20Methods%20Paper.pdf
Fisher, Elliott S.; Wennberg, David E.; Stukel, Therese A.; Gottlieb, Daniel J.; Lucas, F. L.; Pinder, Etoile L. (2003). The Implications of Regional Variations in Medicare Spending. Part 2: Health Outcomes and Satisfaction with Care. Annals of Internal Medicine 138(4): 288-298. doi:10.7326/0003-4819-138-4-200302180-00007
Chetty, Raj; Stepner, Michael; Abraham, Sarah; Lin, Shelby; Scuderi, Benjamin; Turner, Nicholas; Bergeron, Augustin; Cutler, David (2016). The Association Between Income and Life Expectancy in the United States, 2001-2014. JAMA 315(16): 1750-1766. doi:10.1001/jama.2016.4226
Card, David; Dobkin, Carlos; Maestas, Nicole (2009). Does Medicare Save Lives?. The Quarterly Journal of Economics 124(2): 597-636. doi:10.1162/qjec.2009.124.2.597
Maestas, Nicole; Mullen, Kathleen J.; Strand, Alexander (2013). Does Disability Insurance Receipt Discourage Work? Using Examiner Assignment to Estimate Causal Effects of SSDI Receipt. American Economic Review 103(5): 1797-1829. doi:10.1257/aer.103.5.1797
Deshpande, Manasi; Gross, Tal; Su, Yalun (2021). Disability and Distress: The Effect of Disability Programs on Financial Outcomes. American Economic Journal: Applied Economics 13(2): 151-178. doi:10.1257/app.20190709
Snyder, Stephen E.; Evans, William N. (2006). The Effect of Income on Mortality: Evidence from the Social Security Notch. The Review of Economics and Statistics 88(3): 482-495. doi:10.1162/rest.88.3.482

Provenance

Pipeline version: 0.1.0
Build script: book2/chapters/disability-retirement-and-medicare/build.py (sha256 448318b8effa37f391716e2671a8ac83f461cfe2f31c3b3cdb74a7f1b658a33f)
Built on: 2026-10-07
Site commit: c2b1ff3309cb4a10833f884da91ac0057a66ad0a

Inputs

File	Size (bytes)	SHA-256, first 1 MB	SHA-256, last 1 MB
book2/chapters/disability-retirement-and-medicare/disab.py	6,033	00439b80f701784359cee1fe2044ca72f1eb4006baf7f11aa9f605aa89bece63	00439b80f701784359cee1fe2044ca72f1eb4006baf7f11aa9f605aa89bece63
book2/chapters/disability-retirement-and-medicare/hip.py	11,372	9d83106b301ea2bc54e11155a9f2d28a2d71cb78e1ae18831786da97f846be70	9d83106b301ea2bc54e11155a9f2d28a2d71cb78e1ae18831786da97f846be70
book2/chapters/disability-retirement-and-medicare/medi.py	7,713	c8c8e45d1d90f6738eab633a2d8073dbcdb0345313f059ae8d19d30a7c332189	c8c8e45d1d90f6738eab633a2d8073dbcdb0345313f059ae8d19d30a7c332189
book2/chapters/disability-retirement-and-medicare/oasdi.py	11,254	820b615b7769a4de0ba9b5e043228e87d0ea02172e3b87e52eb58a29cc0f8807	820b615b7769a4de0ba9b5e043228e87d0ea02172e3b87e52eb58a29cc0f8807
data/analytic/tract_atlas.parquet	39,659,925	29d5e4d943552d54aeb6ba92aadc939d9bd15bdea553c78357dbd516757be627	1e10d1ecf722340f23ee2212d4999a90250f85b65fa89b39e32db06d9472e22e
data/analytic/zcta_atlas.parquet	674,348,737	0abfad485b74b74eb956fdc57c88e504abe10d601a2e99a3f16467469826578c	0e37a4ce00d8569d49dccd0b2dfdc2c8435934f9c8a606bbca2ca1dad2c9effe
data/raw/acs/deprivation_components_2019_2023/tract.parquet	13,197,793	5545cde2cbe96a8b56e468d65388248a241aa6bd300d3c9e325d08d3f86b11da	5c8ec454d066988b0f1a01aaa6ed34ebfc05d162e01cf9c6bb01f9198cbaff12
data/staged/adi/adi_atlas_tract2020_2023.parquet	798,078	5e409bc212ff871def780fa27b4cf8b616d9da420b2b9f6455517eddcd8c1a95	5e409bc212ff871def780fa27b4cf8b616d9da420b2b9f6455517eddcd8c1a95
data/staged/crosswalks/ct_tract2020_to_old_county.parquet	15,842	961ef39f31596ef65fca2c67d5f2f63e533c5dc9b49745d3bb6437844e4b831d	961ef39f31596ef65fca2c67d5f2f63e533c5dc9b49745d3bb6437844e4b831d
data/staged/health/chr_county_2024.parquet	8,776,933	619795f7ecfec8aff10694b649eaee5e421dbeffbe4be47af4161b51ceefa5cd	c69357f1bcf630407bb9716cb445618838999558c019aaaf77d4681b6bf45c56
data/staged/health/places_tract2020_latest.parquet	5,919,159	af4c3b0d1205b7d84b81676a9529ef73323b2dbeb9d54e235f5efeebfad83177	a2f19029ee2ef032be87e0d5288d88d489afd52379279833f178baa021df3dbf
data/staged/income/irs_soi_zip_2022.parquet	29,261,256	ae6a84e1c187f7b0e1085cc5a2e7048aa3e3ccc4e50030b4ce8e5db11ce09375	2cf093d54788fa8198767866bd9291043066ff9338449c0a9bdfdf93b8189482
data/staged/life_expectancy/health_ineq_county_le_income.parquet	601,631	43cd39b714e143eefe5a3eba108864435ec5d2606f896be1323fc62764bff55a	43cd39b714e143eefe5a3eba108864435ec5d2606f896be1323fc62764bff55a
data/staged/medicare/cms_geo_variation_county_2024.parquet	3,771,529	6fbd23b41d69de745227bdc34cd831c523294c6142eb67ff4466e04cd63d398a	04a6064b1322641cf997c02ccc80f58fcca8f359d5147d6f11026ccdc22ce8c4
data/staged/ses/acs5_tract2020_2019_2023.parquet	7,232,424	5fe6f730a35225f14d5d8abfc6b9bce58b52e545f309a7eac74f1dae74d7a31c	7b4a2475b3852d3f91804716a04566ef8ceadacec2be9fb85f5eb642078efac6
data/staged/social_security/ssa_oasdi_zip_2024.parquet	844,914	9609b3bd5d1838d1c918db5c3519d6fb0d7df3793c1b62b6b70d0b0a4feb9375	9609b3bd5d1838d1c918db5c3519d6fb0d7df3793c1b62b6b70d0b0a4feb9375
data/staged/svi/svi_tract2020_2022.parquet	17,740,415	cb3860d8edc2aaf1f2a02211a58f7a0b80457eb6ad9a37b5ec8abb2d5da9da10	e371a4a696d5bed05d54ad7c5b6ca2504508805b847ec415c2322be7f66ec2b2

Outputs

File	SHA-256
facts.json	9ff34bbcae9bdf00191de17cf396fec86f8485d0c6e8ca7921d5ae0c4b04fbf6
figures/alt_rankings.json	2f174623d60889d3db6dc07afecd828379c703363700dd058f5e9f54c0852012
figures/benefit_vs_income.json	c3ae37a7cd33c2790a14646974d4ec95b0e203b203490fc81825067b34df94bc
figures/disability_gradient.json	3275b35c2b470ec413dc94c8610de3a0433d0c045c74557c1d39e7cfbc820406
figures/medicare_spending.json	2b213e89a79fdd6668c7cd45010381cad8f5536df3e7a1175ffbff6437cf9597
figures/oasdi_mix.json	284dedf467972c99fca829dc2c230f82f6e4572a98781a3cd9c769b612ef4ea8
figures/poor_le_correlates.json	5a229bd2369a84f7a63461f87d0b1aa4c509d00c87d2e85892e68995e6807448
figures/poor_le_map.json	6cc362ada14fbbe49908982708cd2b6d332ce73954d8eab1c4aef4b895a03e08
figures/poor_vs_rich_le_at_40.json	c8831dcba7eba9a66412914bc287f223bc45c67f0bc7071917116f7d79b11792
meta.json	82938135b4a0616d19b01d7d80b96405aa990154aa8238c14c73c7dd1c517ee4
public/data/disability-retirement-and-medicare/benefit_vs_income.json	08a2ca13dc889b122c14e3eb94cc17ee02becd0f445af52796d411c48bf87127
public/data/disability-retirement-and-medicare/disability_by_age.json	f1eb842f96495215dad71700b36ca35a61a81b9b488af430a9544f3cb7448948
public/data/disability-retirement-and-medicare/poor_le_map.json	21ba92bdb1a41dc88d2bcad68f8eb5bd4a9934000c5e9f2dca61605796882faf
public/data/disability-retirement-and-medicare/poor_vs_rich_le_at_40.json	a0bab32a076197cf2e54e3de3a1be10213001700e23f1f12af1c3bf49e36b96b
public/data/disability-retirement-and-medicare/spend_vs_life_expectancy.json	d10d2bd3f517299b673834b2bf16dbbe712209e03d542449a70f7d211c9532a3
refs.json	79173fe5e0203880ecf85d35f7defa871b3823208a115150c822b6de2be49030

Machine formats

Report (Markdown): https://vishalsingh.org/zipcode/disability-retirement-and-medicare/report.md
Every estimate (JSON): https://vishalsingh.org/zipcode/report/disability-retirement-and-medicare/facts.json
Table 1, figure "disability_gradient" (JSON): https://vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/disability_gradient.json
Table 2, figure "oasdi_mix" (JSON): https://vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/oasdi_mix.json
Table 3, figure "benefit_vs_income" (JSON): https://vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/benefit_vs_income.json
Table 4, figure "medicare_spending" (JSON): https://vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/medicare_spending.json
Table 5, figure "poor_le_map" (JSON): https://vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/poor_le_map.json
Table 6, figure "poor_vs_rich_le_at_40" (JSON): https://vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/poor_vs_rich_le_at_40.json
Table 7, figure "poor_le_correlates" (JSON): https://vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/poor_le_correlates.json
Table 8, figure "alt_rankings" (JSON): https://vishalsingh.org/zipcode/report/disability-retirement-and-medicare/figures/alt_rankings.json
Payload of "disability_gradient" (JSON): https://vishalsingh.org/zipcode/data/disability-retirement-and-medicare/disability_by_age.json
Payload of "benefit_vs_income" (JSON): https://vishalsingh.org/zipcode/data/disability-retirement-and-medicare/benefit_vs_income.json
Payload of "medicare_spending" (JSON): https://vishalsingh.org/zipcode/data/disability-retirement-and-medicare/spend_vs_life_expectancy.json
Payload of "poor_le_map" (JSON): https://vishalsingh.org/zipcode/data/disability-retirement-and-medicare/poor_le_map.json
Payload of "poor_vs_rich_le_at_40" (JSON): https://vishalsingh.org/zipcode/data/disability-retirement-and-medicare/poor_vs_rich_le_at_40.json
Index of every report: https://vishalsingh.org/zipcode/llms.txt; all reports in one file: https://vishalsingh.org/zipcode/llms-full.txt

Identification

Principal estimates

Findings

Disability rises with neighborhood deprivation, and age accounts for little of it

Disabled workers are a larger share of beneficiaries in deprived ZIP codes

The size of a retired worker's benefit follows ZIP code income

Medicare payments show no detectable difference across county deprivation, but their mix differs

Weighted by residents, the poorest income quartile's expected age at death varies more across counties

Adult disability rises across tracts under all four rankings

What these data cannot show

Tables

Table 1. Adult disability is 23.3% in the least deprived tenth of census tracts and 42.9% in the most deprived, and it differs by 1.8 points between tenths of tracts with few and many older residents

Table 1.1. By deprivation

Table 1.2. By age structure

Table 2. Disabled workers are 16.8% of Social Security beneficiaries in the most deprived fifth of ZIP codes and 7.2% in the least deprived, and retired workers are 65.9% against 80.5%

Table 3. The average monthly retired-worker benefit rises with ZIP code income, from $1,554 in the lowest tenth of ZIP codes to $2,370 in the highest, a correlation of +0.84

Table 4. Price-standardized Medicare payments are $12,680 per fee-for-service beneficiary in the least deprived fifth of counties and $13,176 in the most deprived, a difference whose interval includes zero

Table 4.1. Service lines

Table 4.2. Life expectancy

Table 4.3. Emergency visits

Table 5. Expected age at death at 40 for the poorest income quartile runs from 77.5 in the county at the fifth percentile to 81.8 in the county at the ninety-fifth

Table 6. Weighted by residents, county values of expected age at death at 40 span 4.3 years between the 5th and 95th percentiles for the poorest income quartile and 3.0 for the richest

Table 7. Across counties weighted by residents, the poorest quartile's expected age at death correlates −0.67 with the county ADI, −0.64 with obesity and −0.58 with smoking, and −0.15 with the uninsured share

Table 8. Adult disability is steadily worse toward the more deprived end under the ADI and under each of the three other rankings

All estimates

Definitions

Methods

How disability and tooth loss are measured

How places are ranked and grouped by deprivation

How Social Security and pension data are matched to ZIP codes

What the Medicare payments cover

How expected age at death is measured and weighted

How intervals, ranges and plotted samples are computed

Four rankings of the same places

What these data cannot show

References

Provenance

Machine formats