ERS Charts of Note
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Thursday, June 22, 2023
The number of primary care physicians per 10,000 residents is generally higher in much of the Northeast, along the West Coast, in Hawaii, and parts of the mountainous West and upper Midwest. The availability of primary care physicians per capita is generally lower in much of the Great Plains—especially the Southern Great Plains—and the Lower Mississippi Delta and Southeast. However, there are substantial variations in the availability of physicians within these regions. For instance, in rural counties, there are fewer physicians per capita in counties adjacent to urban counties than in those farther from urban areas. This is likely because residents travel from nearby rural areas to urban doctors. The lowest rates of physicians per capita are in rural counties with an urban population of less than 2,500. This chart updates data appearing in the USDA, Economic Research Service report Linkages Between Rural Community Capitals and Healthcare Provision: A Survey of Small Rural Towns in Three U.S. Regions published in March 2023.
Monday, June 12, 2023
The availability of healthcare professionals in rural areas lags that of urban areas, partly because of difficulties in recruiting and retaining healthcare professionals. When choosing rural locations to practice, healthcare professionals (physicians, nurse practitioners, physician assistants, certified nurse midwives, and dentists) most often cite social aspects, such as the friendliness of the town, as an important factor in their decision, according to a survey administered by researchers at USDA, Economic Research Service (ERS) and Iowa State University. Similar factors come into play when these professionals choose to stay in their rural small towns. Other factors that reflect the importance of social relationships included being a good place to raise family, having relatives or friends living nearby, familiarity with the area (for the initial location decision), the quality of professional contacts and collegiality among local healthcare professionals (investigated only for the decision to stay), and if the professional’s family was settled in the town (also only investigated for the decision to stay). Other factors, such as the quality of the medical community, the quality of schools, and opportunities for professional growth also were cited as important. This chart appears in the ERS report Linkages Between Rural Community Capitals and Healthcare Provision: A Survey of Small Rural Towns in Three U.S. Regions, published in March 2023, as well as the Amber Waves article Healthcare Professionals Seek Social Connections When Moving to Rural Towns, published in May 2023
Monday, April 3, 2023
The availability of healthcare professionals in rural areas lags that of urban areas. As of 2020, rural (nonmetro) areas recorded 5.1 primary care physicians per 10,000 residents, while the number in urban (metro) areas was 8.0. Similarly, the number of dentists was 4.7 in rural areas compared with 7.6 in urban areas, while the number of nurse practitioners, physician assistants, and certified nurse midwives was 11.1 in rural areas compared with 14.7 in urban areas. Lower availability of primary healthcare services has been associated with a higher likelihood of poor health and lower life expectancy. Healthcare services are important not only for people’s health, but also for rural economies. Further, the healthcare services sector is one of the largest and most rapidly growing economic sectors across all parts of the United States. This chart appears in the Economic Research Service report, Linkages Between Rural Community Capitals and Healthcare Provision: A Survey of Small Rural Towns in Three U.S. Regions published in March 2023.
Monday, March 20, 2023
Formal educational attainment in rural America has grown over time, but rural (nonmetro) areas still lag urban (metro) areas. From 2000 to 2017–21 (the most recent estimate period from the American Community Survey), the share of adults ages 25 and older with a bachelor’s degree or higher increased in rural areas from 15 to 21 percent. In the same time span, the share of adults in urban areas with a bachelor’s degree or higher increased from 26 to 36 percent, widening the rural-urban gap from 11 to 15 percentage points in these two reference periods. This rural-urban gap in the share of people with at least a bachelor’s degree is even larger for younger age groups. In 2017–21, the share of working-age adults (ages 25–64) with at least a bachelor’s degree was 37 percent in urban areas and 21 percent in rural areas, while the share of younger adults ages 25–44 with at least a bachelor’s degree was 40 percent in urban areas and 22 percent in rural areas. One explanation for the persisting and widening gap may be the higher pay that more highly educated workers can often earn in urban labor markets. This chart appears in the USDA, Economic Research Service data product Charting the Essentials, published in January 2023.
Thursday, March 9, 2023
The Coronavirus (COVID-19) pandemic affected unemployment rates differently in rural and urban counties. In January 2020, just before the pandemic, the unemployment rates in both persistently poor and not persistently poor rural counties were higher than in the respective urban counties. In addition, the unemployment rates in persistently poor rural counties were higher than in rural counties that were not persistently poor (5.9 percent versus 4.6 percent). This pattern changed with the pandemic-driven economic downturn. By April 2020, the unemployment rate among persistently poor rural counties had more than doubled to a peak of 12.3 percent. However, in other rural counties the unemployment rate had nearly tripled, surpassing the unemployment rate in persistently poor rural counties with a peak of 13.4 percent. Similarly, in urban counties the unemployment rate nearly tripled (from 4.9 percent to 14.4 percent) for persistently poor counties and more than tripled for other urban counties (from 3.8 percent to 14.2 percent), surpassing the unemployment rates in rural counties. These unemployment rate changes suggest that the employment shock at the start of the pandemic was not as prominent in persistently poor counties as in counties that were not persistently poor, and that it had a larger effect on urban counties than rural counties. The varying effects of the pandemic might in part be traced to whether local industries stayed open (essential industries, such as meatpacking), or saw reduced demand, such as retail and hospitality. Unemployment rates in rural counties returned to pre-pandemic levels by November 2021, but persistently poor urban counties did not recover until December 2022 and continue to have the highest unemployment rates. This chart updates data in the USDA, Economic Research Service report Rural America at a Glance: 2021 Edition, published in November 2021.
Wednesday, December 14, 2022
In 1960, 78 percent (2,412) of U.S. counties had poverty rates of 20 percent or more. Among them, 28 percent (680) continued to have high poverty through 1980. After enactment of the Economic Opportunity Act of 1964, commonly known as the War on Poverty initiatives, many counties reported reduced poverty rates. Between 1980 and 2019, poverty rates were relatively stable, mainly fluctuating with cyclical changes in the macroeconomy. As of 2019, there were 304 counties—13 percent of the counties with high poverty in 1960—that consistently had poverty rates of 20 percent or more over the last 60 years. The majority—264 counties—are rural counties and are clustered in the Appalachian States; the Black Belt in the South; the Mississippi Delta; the Ozarks region of Missouri, Arkansas, Oklahoma, and southeast Kansas; the Southwest; and in counties with large American Indian and Alaska Native populations. This chart is a version of an interactive map on USDA, Economic Research Service’s Poverty Area Measures data product, updated November 2022.
Friday, November 25, 2022
According to U.S. Census Bureau estimates for 2015-19, there were 469 nonmetropolitan (nonmetro) counties with a poverty rate of 20 percent or more, which USDA, Economic Research Service (ERS) designates as high poverty. The high poverty classification in more than half of the counties (236) is characterized by a concentration of poverty within racial and ethnic minority groups, including Black or African American (153 counties), Hispanic (49 counties) and American Indian and Alaska Natives (34 counties). Many of the American Indian and Alaska Native high poverty counties are areas of historic tribal presence or were designated as reservation settlements in the 19th century. The average poverty rate for those 34 counties is 31.5 percent for the total population and 40.5 percent for the American Indian and Alaska Native population alone, a level considered to be extreme poverty. The average poverty rates for the other racial-ethnic high poverty county types are below 30 percent for the total population and below 40 percent for the Black or African American and Hispanic population groups. This chart uses information from the ERS Atlas of Rural and Small-Town America to update information on the Rural Poverty and Well-being topic page and the Amber Waves feature Anatomy of Nonmetro High-Poverty Areas: Common in Plight, Distinctive in Nature, published in February 2004.
Thursday, November 10, 2022
USDA, Economic Research Service’s (ERS) analysis of the American Community Survey estimates for 2015–19 reveal the poverty rate for veterans to be nearly 5 percentage points lower than for non-veteran adults (8.2 percent compared to 12.8 percent). However, in many areas of the nation, veterans have higher poverty rates than nonveterans, especially in nonmetropolitan counties. During the 2015–19 data period, there were 248 counties with a high rate of poverty (equal to or greater than 20 percent) for the veteran population. The adult non-veteran population had high poverty rates in less than half of those counties (119). Of the 129 counties in which only veterans had high poverty, there were 15 counties with extreme high poverty rates (equal to or greater than 40 percent) for veterans. Across all the 248 counties in which there was high veteran poverty, nearly 90 percent (219 counties) were nonmetropolitan counties. This chart uses data found in the ERS Atlas of Rural and Small-Town America and updates statistics that appear in the ERS Economic Brief Rural Veterans at a Glance, published in November 2013.
Wednesday, August 24, 2022
Households in rural (nonmetropolitan) persistently poor counties were the least likely to have home internet in 2015-19, with more than 3 in 10 households lacking internet access at home. In comparison, only 2 in 10 households in rural counties that were not persistently poor had no internet access at home. A similar pattern was observed in urban (metropolitan) areas, with 2 in 10 households in persistently poor counties lacking home internet access. Only a little more than 1 in 10 households in urban counties that were not persistently poor had no internet access at home. These data illustrate two major trends. First, rural households were less likely to have internet subscriptions at home than urban households. Second, in persistently poor counties, whether rural or urban, a higher share of households lacks internet adoption than in counties that are not persistently poor. For households with internet access at home, service was mainly through a subscription, which includes a range of access from dial-up to broadband to cellular data plans. These gaps in at-home internet access and subscriptions suggest that households in persistently poor counties—and more specifically, households in rural persistently poor counties—had additional barriers to internet adoption. This chart appears in the USDA, Economic Research Service report Rural America at a Glance: 2021 Edition, published in November 2021.
Monday, August 1, 2022
Self-employed workers were more than twice as likely to lack health insurance compared with those employed by private firms or government in 2018, regardless of whether they lived in metropolitan or nonmetropolitan counties. Self-employed working-age adults (ages 26–64) with health insurance were covered more widely across sources. Like those employed by private firms and government, they were insured through employer-based group health insurance plans more than any other source. (Many of these individuals could be receiving coverage through another household member’s employer-based plan.) Even so, a much smaller share of self-employed workers was covered by employer-based plans than those employed by private firms or government (50.5 percent versus 82.4 percent, respectively, in nonmetro counties). Instead, self-employed working-age adults were insured through direct-purchase health insurance plans at more than three times the rate of those employed by private firms or government. Similarly, public health insurance (e.g., Medicaid, Medicare) rates for self-employed working-age adults were nearly twice that of those employed by private firms or government. A version of this chart appears in the ERS publication Health Care Access Among Self-Employed Workers in Nonmetropolitan Counties published May 2022.
Wednesday, July 27, 2022
As the effects of the Coronavirus (COVID-19) pandemic deepened in 2020, a greater share of employed people reported lacking health insurance coverage, regardless of residential location or whether they were self-employed. Self-employed workers were already more often uninsured than those employed by private industry or government, and the gap persisted through the end of 2020. Self-employed workers started the pandemic with uninsured rates of between 24 percent and 28 percent, and these rates remained relatively stable through July 21, 2020. Thereafter, the percentage of uninsured individuals increased, and between August 19 and December 21, 2020, around 33 to 34 percent of self-employed workers were uninsured. The rates of uninsured individuals among other workers followed the same trend, with rates of 15 to 16 percent at the beginning of the pandemic increasing to around 27 percent by the end of 2020. The increases correspond both to a decrease in health insurance coverage through employer-based plans as job losses grew and to slight declines in coverage through direct-purchase plans among the self-employed. This chart appears in the ERS publication report Health Care Access Among Self-Employed Workers in Nonmetropolitan Counties, published May 2022.
Thursday, July 7, 2022
To understand how the availability of health care for self-employed workers in metropolitan and nonmetropolitan areas has changed over time, researchers at USDA, Economic Research Service (ERS) examined the average rate of doctors with medical degrees (not with osteopathic degrees) per 10,000 people. In this chart, they focused on differences between metropolitan and nonmetropolitan counties with high and low rates of self-employment. The researchers found that between 1960 and 2017, doctors have been far more available in metropolitan counties with low self-employment rates than in other counties. They also found that doctors have been the least available in nonmetropolitan counties with high self-employment rates. The largest gap in doctor availability existed between these two groups: in 2017, there was an average of 23 doctors per 10,000 residents in low self-employment metropolitan counties versus 7 doctors in high self-employment nonmetropolitan counties. However, the average rates of doctors and trends in those rates have changed over time. Between 1970 and 2000, the average rate of doctors increased in both metropolitan and nonmetropolitan counties. But since 2000, the average rate of doctors started to decrease in nonmetropolitan counties. By 2017, the average rate of doctors in low self-employment nonmetropolitan counties fell below the rate in high self-employment metropolitan counties. Thus, people living in nonmetropolitan counties, particularly those with a higher proportion of self-employed workers, generally had less access to doctors. A version of this chart appears in the ERS publication Health Care Access Among Self-Employed Workers in Nonmetropolitan Counties, published May 2022.
Friday, January 14, 2022
Access to fast internet speeds has been crucial throughout the Nation with the increased online presence of school, work, and shopping due to the (Coronavirus) COVID-19 pandemic. In June 2019, the moderate- or high-speed broadband internet needed for high-quality video calls was available in the census blocks of more than 90 percent of U.S. residents. In rural counties, however, only 72 percent residents had access to those internet speeds. Only 63 percent of rural residents in counties with persistent poverty had moderate or high-speed broadband available in their census blocks. Counties are considered persistently poor if they have a poverty rate of 20 percent or more for four consecutive U.S. Census measurements dating back to 1980. Among persistently poor rural counties, high availability of moderate or high-speed internet was clustered in and around eastern Kentucky and southern Texas. Rural persistently poor counties in the Deep South and Southwest had low internet availability, as did rural counties in the lower Great Plains and western Mountain States that were not persistently poor. Rural counties without persistent poverty that had high internet availability were scattered throughout the eastern half of the United States and clustered in the upper Great Plains and eastern Mountain States. This map was first published in the USDA, Economic Research Service report Rural America at a Glance: 2021 Edition.
Friday, January 7, 2022
The Coronavirus (COVID-19) pandemic affected unemployment rates differently in rural and urban counties. In January 2020, just before the pandemic, the unemployment rates in rural counties, both persistently poor and not, were higher than in urban counties. In addition, the unemployment rates in persistently poor counties were higher than in counties that were not persistently poor (6 percent versus 4.6 percent, respectively, for rural counties). That changed with the pandemic-driven economic downturn. By April 2020, the unemployment rate among persistently poor rural counties had more than doubled to a peak of 12.6 percent. However, in other rural counties the unemployment rate had more than tripled, surpassing the unemployment rate in persistently poor rural counties with a peak of 13.7 percent. Similarly, in urban counties the unemployment rate more than tripled for persistently poor counties and quadrupled for other urban counties, surpassing the unemployment rates in rural counties. These changes in the unemployment rate suggest that the employment shock at the start of the pandemic was not as prominent in persistently poor counties as in counties that were not persistently poor, and that it had a larger effect on urban counties than rural counties. These changes are possibly due to differing employment dependence on industries that remained in operation, such as meatpacking, or that had less demand, such as retail and hospitality. By June 2020, the unemployment rate in not persistently poor rural counties had again fallen below the rate in persistently poor rural counties, while the rate in not persistently poor urban counties again fell below the rate in persistently poor rural counties by October 2020. As of October 2021, the unemployment rates in rural counties had returned to what they were before the pandemic, but the unemployment rate remained elevated in persistently poor urban counties. This chart updates data in the USDA, Economic Research Service report Rural America at a Glance: 2021 Edition, published in November 2021.
Thursday, November 18, 2021
The public rollout of Coronavirus (COVID-19) vaccinations in the United States began in mid-December 2020. The early phases of vaccination prioritized frontline health care workers, adults age 65 and over, individuals with high-risk medical conditions, and essential workers. During this period, vaccination rates in metro (urban) and nonmetro (rural) counties increased at about the same rate, and by mid-April 2021, total vaccination rates for the Nation were slightly above 20 percent. After April 19, 2021, when all adults became eligible for vaccination, the share of fully vaccinated residents increased faster in metro counties than in nonmetro counties. In addition, the vaccination rate was consistently lower in persistently poor counties than in counties that were not persistently poor. Persistently poor counties are counties in which 20 percent or more of the population lived at or below the Federal poverty line during four consecutive U.S. census measurements dating to 1980. In July 2021, the highly infectious Delta variant began to spread. Rural persistently poor counties led the Nation in new infections through much of this surge, and the gap in vaccination rates between persistently poor and other counties started to close in mid-August. However, the rural-urban vaccination gap persisted. By early October 2021, the vaccination rate in urban counties had reached 53 percent, while the vaccination rate in rural counties was about 42 percent. This chart is included in the USDA Economic Research Service report Rural America at a Glance: 2021 Edition, published November 17, 2021.
Monday, August 23, 2021
Across all races and ethnicities, U.S. poverty rates in 2019 were higher at 15.4 percent in nonmetro (rural) areas than in metro (urban) areas at 11.9 percent. Rural Black or African American residents had the highest incidence of poverty in 2019 at 30.7 percent, compared with 20.4 percent for that demographic group in urban areas. Rural American Indians or Alaska Natives had the second highest rate at 29.6 percent, compared with 19.4 percent in urban areas. The poverty rate for White residents was about half the rate for either Blacks or American Indians at 13.3 percent in rural areas and 9.7 percent in urban settings. Rural Hispanic residents of any race had the third highest poverty rate at 21.7 percent, compared with 16.9 percent in urban areas. Non-Hispanic White residents had the lowest poverty rates in both rural (12.7 percent) and urban (8.2 percent) areas in 2019. This chart appears in the Economic Research Service topic page for Rural Poverty & Well-Being, updated June 2021.
Wednesday, August 11, 2021
A recent USDA, Economic Research Service study of U.S. poverty identified 310 counties—10 percent of all counties—with high and persistent levels of poverty in 2019. High and persistent poverty counties had poverty rates of 20 percent or more in 1980, 1990, 2000, and on average for 2007-2011 and 2015-2019. Of those 310 counties, 86 percent, or 267 counties, were rural (nonmetro). These rural counties were concentrated in historically poor areas of the Mississippi Delta, Appalachia, the Black Belt, and the southern border regions, as well as on Federal Indian reservations. More than 5 million rural residents, or about 12 percent of the U.S. rural population, lived in counties that had high and persistent poverty rates in 2019. Of those, 1.5 million individuals had incomes below the Federal poverty threshold, accounting for 20 percent of the total rural poor population. Rural residents who identify as Black or African American and American Indian or Alaska Native were particularly vulnerable. Nearly half the rural poor within these groups lived in high and persistent poverty counties in 2019. By comparison, 20 percent of rural poor Hispanics and 12 percent of rural non-Hispanic Whites lived in those counties. This chart appears in the August 2021 Amber Waves finding, Rural Poverty Has Distinct Regional and Racial Patterns.
Friday, May 28, 2021
Early during the Coronavirus (COVID-19) pandemic, U.S. employment fell at rates not seen since the Great Depression, with the greatest declines occurring in metro areas. Before the pandemic, employment growth in metro areas had averaged 1.4 percent per year for the 12 months prior to March 2020, more than twice the rate in nonmetro areas (0.6 percent per year). After March 2020, the situation reversed. In April 2020, metro employment was 15.0 percent below 12 months earlier, while nonmetro employment was 12.2 percent lower. Employment has since largely recovered in both metro and nonmetro areas but remained lower in February 2021 than levels 12 months earlier. The extent to which employment was still depressed in February 2021 is greater in metro areas: Metro employment was 5.7 percent lower in February 2021 than in February 2020, while nonmetro employment was 3.4 percent lower. This chart appears in the Economic Research Service topic page, The COVID-19 Pandemic and Rural America, updated May 2021.
Friday, April 2, 2021
Since the late 1990s, an opioid epidemic has afflicted the U.S. population, particularly those in the prime working ages of 25-54. As a result, the National age-adjusted mortality rate from drug overdoses rose from 6.1 per 100,000 people in 1999 to 21.7 per 100,000 in 2017, then dipped to 20.7 per 100,000 in 2018 and rose back to 21.6 in 2019. Among the prime working age population, the drug overdose mortality rate was 37.8 deaths per 100,000 people in 2019. This rate was exceeded only by cancer (39.2 deaths per 100,000) in 2019 as a major cause of death in this population. ERS researchers, examining the opioid epidemic from 1999 to 2018, observed two distinct phases: a “prescription opioid phase” (1999-2011) and a succeeding “illicit opioid phase” (2011-2018), marked especially by the spread of fentanyl and its analogs. Updated data show the second phase has extended into 2019. Mortality data indicate that in the prescription opioid phase, drug overdose deaths were most prevalent in areas with high rates of physical disability, such as central Appalachia. Rural residents, middle-age men and women in their 40s and early 50s were most affected, as were Whites and American Indian/Alaskan Natives. Opioid prescriptions ceased driving the epidemic in 2011 as increased regulation and greater awareness of prescription addiction problems took hold. The illicit opioid phase that followed involved primarily heroin and synthetic opioids, such as fentanyl. Fentanyl and its analogs are often used to spike other addictive drugs, including prescription opioids, creating powerful combinations that make existing drug addictions more lethal. During the study period, this second phase was concentrated in the northeastern United States, particularly in areas of employment loss. This phase most often involved urban young adult males, ages 25 to 39. All the racial/ethnic groups studied—Hispanics, Blacks, American Indian/Alaskan Natives, and Whites—were affected. This chart updates data found in the Economic Research Service report The Opioid Epidemic: A Geography in Two Phases, released April 2021.
Friday, March 19, 2021
During the initial COVID-19 surge between March and June 2020, large urban areas had the highest weekly death rates from the virus in the United States. Those numbers declined as medical professionals learned more about the virus, how to treat it, and how to prevent its spread. As the virus spread from major urban areas to rural areas, the second COVID-19 surge, from July to August 2020, brought more deaths to rural areas. The peak in deaths associated with this surge was smaller because testing was more widespread, the infected population was younger and less vulnerable, and treatments were more effective. However, in early September 2020, COVID-19 death rates in rural areas surpassed those in urban areas. This trend continued into a third, still ongoing, surge that spiked in rural areas during the holiday season and again shortly thereafter. Rural areas have shown higher death rates per 100,000 adults since September in part because they had higher rates of new infections than urban areas, but that is not the whole story. Rural COVID-19 deaths per 100 new infections 2 weeks prior (to account for the lag between infection and death) were 2.2 in the first 3 weeks of February—35 percent higher than the corresponding urban mortality rate of 1.6 deaths per 100 new infections 2 weeks earlier. The rural population appears to be more vulnerable to serious infection because of the older age of its population, higher rates of underlying medical conditions, lack of health insurance, and greater distance to an intensive care hospital. As of early February, death rates have started decreasing, possibly because of more widespread vaccinations among the most vulnerable populations. This chart updates data found in the February 2021 Amber Waves data feature, “Rural Residents Appear to be More Vulnerable to Serious Infection or Death from COVID-19.”