# Disability, retirement and Medicare: report

Chapter 7.4 of ZIP Code Destiny, by Vishal Singh (NYU Stern). Generated from the chapter's data files; the reading version is at https://vishalsingh.org/zipcode/disability-retirement-and-medicare. Table n of this report is figure n of the chapter.

## 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: 2026-10-09
- 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
- Report: https://vishalsingh.org/zipcode/disability-retirement-and-medicare/report
- Markdown: https://vishalsingh.org/zipcode/disability-retirement-and-medicare/report.md
- BibTeX key: singh2026disabilityretirementandmedicare

```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.

| 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.

 (Note: 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

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

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 (https://vishalsingh.org/zipcode/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 evidence: What eligibility rules and cash benefits change for the people they reach (Regression discontinuity; instrumental variables (examiner assignment); difference-in-differences)
>
> 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 (https://vishalsingh.org/zipcode/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 (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.

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

## All estimates

Every fact in facts.json (165), sorted by id.

| 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).

Explains Table 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.

### How Social Security and pension data are matched to ZIP codes

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.

Explains Table 2 and Table 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.

Explains Table 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).

Explains Table 5, Table 6 and Table 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.

Explains Table 8.

## 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 (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.

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.

## References

1. 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. https://doi.org/10.1056/NEJMp1802313
2. 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. https://doi.org/10.5888/pcd19.210459
3. 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. https://data.cms.gov/sites/default/files/2026-05/Original%20Medicare%20Geographic%20Variation%20Public%20Use%20File%20Methods%20Paper.pdf
4. 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. https://doi.org/10.7326/0003-4819-138-4-200302180-00007
5. 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. https://doi.org/10.1001/jama.2016.4226
6. Card, David; Dobkin, Carlos; Maestas, Nicole (2009). Does Medicare Save Lives?. The Quarterly Journal of Economics 124(2): 597-636. https://doi.org/10.1162/qjec.2009.124.2.597
7. 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. https://doi.org/10.1257/aer.103.5.1797
8. 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. https://doi.org/10.1257/app.20190709
9. 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. https://doi.org/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 (HTML): https://vishalsingh.org/zipcode/disability-retirement-and-medicare/report
- 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