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A smaller share of people in their prime working years (25-54) are employed now than in decades past, and some have wondered whether disabilities and health problems have played a role in that decline. People with disabilities have much lower employment rates than people without disabilities, and disabilities are one of the most commonly cited reasons for not working. Moreover, a recent Brookings report identified particular subgroups among the out-of-work as having disproportionately high rates of disability.
With that as context, we set out to better understand the role of geography and demography in patterns of disability among prime-age adults. Disability can take many forms, but the Centers for Disease Control provides a useful general definition: disability is any condition of the body or mind that makes it more difficult for the person with the condition to do certain activities and interact with the world around them. The onset of disability can also take many forms: it may present itself at birth, stem from an accident or injury, or result from a long-standing condition or disease, among other causes.
Nine percent of adults aged 25 to 54, or 11 million Americans, reported at least one of six disabilities in 2016. Some patterns by place and demographics are already well-established: disability is disproportionately concentrated in the Southeast, Midwest and Appalachian areas (the so-called “disability belt”), and people with disabilities disproportionately include people with low levels of education and incomes. But analyses at the metropolitan level are less common, and given the regional nature of labor markets, regional-level data should inform efforts to help people with disabilities.
This analysis uses data from the American Community Survey (ACS) to examine disability rates of the 100 largest metropolitan areas, as well as differences by education and race/ethnicity. We do not limit our analysis to those receiving disability benefits, but rather include all who report a disability, in order to provide a broad picture of those with disabilities in the United States and where they live.
Metros show wide variation in disability rates
Disability rates range considerably among the country’s 100 largest metropolitan areas, from just under 4 percent up to 13 percent.
Places with the lowest disability rates have strong economies and well-educated populations, such as San Jose, Los Angeles, and San Francisco in California; Madison, Wisc.; Austin, Texas; and Washington, D.C. Metropolitan areas with the highest disability rates are located both within and outside of the disability belt. Some have historically manufacturing-based or industrial economies, such as Scranton, Pa.; Birmingham, Ala.; Toledo, Ohio; and Spokane, Wash. Others, like Tucson, Ariz.; Deltona, Fla.; and El Paso, Texas have large tourism or agricultural sectors that employ many workers with low levels of education.
Disability by race/ethnicity varies within and between metros…
At the national level, Native Americans have the highest disability rate among working-age adults (16 percent), followed by blacks (11 percent), whites (9 percent), Hispanics (7 percent), and Asians (4 percent).
Yet disability rates by race and ethnicity also vary greatly among metro areas. As Figure 1 shows, Asians exhibit both low levels of disability and relatively small variation between places, ranging from 2 percent to 13 percent. Blacks and Hispanics both exhibit wider ranges, from the low single digits to about 20 percent. In most places, as at the national level, blacks have higher disability rates than whites, up to 2.5 times greater. In a number of metro areas, however (concentrated in Florida, North Carolina, and Connecticut), blacks have the same or lower disability rates than whites. Similarly, although Hispanics have lower disability rates than most other races/ethnicities at the national level, they are more likely to be disabled than whites and blacks in metro areas such as Spokane, Wash.; Springfield, Mass.; Deltona, Fla.; and Allentown and Pittsburgh in Pennsylvania.
…but the differences by education are much larger
Among the entire prime-age population in the United States, the disability rate among those with only a high school diploma is three times higher than among those with a bachelor’s degree (12 percent and 4 percent, respectively). In a number of places, however, that gap is even greater, particularly in formerly industrial metro areas in Ohio (Akron, Cincinnati, Columbus, Toledo, Youngstown), Pennsylvania (Scranton and Pittsburgh), and Massachusetts (Springfield and Worcester).
In some ways, these data are not surprising. As noted above, people with disabilities have lower educational levels than people without disabilities, and education is a powerful predictor of health status in general. But the size of the gap is sobering and points to a complicated relationship between education and disability. Even in a post-ADA world, people with disabilities can face barriers to completing their education, and education is linked to overall health in myriad ways, including individual health knowledge and behaviors, access to health care, exposure to environmental toxins, and jobs that are more physically demanding or dangerous.
Geography also interacts with education and disability. Low education is more strongly associated with disability in some regions than others, suggesting that education is one of a number of factors that influence local disability rates. But the relationship between disability and geography is long-standing: researchers have noted it for decades, suggesting the patterns have deep roots in industrial and sociocultural conditions.
Our next post will dive deeper into employment trends among people with disabilities in their prime working years, with a continued focus on trends by race, education, and geography. Both job availability and demographics vary markedly around the country, requiring local leaders to craft employment and service interventions tailored to local needs.
The authors thank Cecile Murray for her help conceptualizing and carrying out the data analysis for this blog.
Disabilities are defined as having difficulties in the following areas: vision, hearing, the ability to walk or climb stairs, cognition (remembering, concentrating, or making decisions), self-care (dressing or bathing), and independent living (doing errands alone such as visiting a doctor’s office or shopping).
By James Thomas Rook Jr.
As my wife and I are preparing to adopt five children, and knowing historically how many elders' children have abandoned the Truth, for whatever reasons there might be, common to mankind ... the thought occurred to me ... Were all of the Apostles Single?
If any were married, how did they balance their responsibilities to their families, with the field ministry?
If they were in the Ministry, were they supported by the congregations from the Apostles money box ... and were their families also supported as they rove about ministering about the Good News?
If so, that would indicate a paid clergy !
I suppose it all hinges on he first question.
WERE ALL OF THE APOSTLES SINGLE ?
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By Guest Nicole
MEXICO CITY, Mexico—While the world awaits a Zika vaccine, the first ever injection against dengue fever is spreading, with Mexico becoming next week the latest country where people can get the shot.
French pharmaceutical giant Sanofi is presenting its Dengvaxia vaccine to doctors at an event in eastern Mexico on Saturday, while people aged nine to 45 will be able to get the shot from their physicians from Monday.
After public programs were launched in the Philippines and Brazil’s state of Parana this year, the company is rolling out the vaccine in the private sector in Mexico while health authorities prepare a public immunization plan.
The head of Sanofi’s dengue program, Guillaume Leroy, told Agence France-Presse in Mexico City that the company already has one million doses ready in the country.
Leroy said it was difficult to estimate how much the vaccine will cost in Mexico as it will depend on the distribution networks and the public vaccination program.
The mosquito-borne virus costs governments around the world $18 billion a year, Leroy said.
“We estimate that in Mexico and in other countries that the benefits will outweigh the costs of the (vaccine) intervention,” he said.
The company will have a “fair policy throughout the world and affordable for health authorities.”
Mexico was the first country in the world to give regulatory approval to the vaccine in December last year. Seven others followed suit, including Brazil, Costa Rica, El Salvador, Guatemala, Paraguay, Peru and the Philippines.
Sanofi is awaiting authorizations in 18 other countries.
The fast-growing disease infects as many as 400 million people every year, according to the World Health Organization (WHO), which has endorsed the vaccine.
Sanofi’s research and development work took 20 years, costing more than 1.5 billion euros ($1.7 billion).
Now, Sanofi and other pharmaceutical firms are racing to find a weapon against Zika, which like dengue is carried by the Aedes aegypti mosquito.
“Developing a vaccine against Zika will be easier after developing a vaccine against dengue,” Leroy said, noting that the viruses share genetic similarities.
“All these investments (on dengue) through more than 100 collaborations worldwide allow us today to gain a lot of time on different vaccinal approaches” against Zika, he said.
Some 70 countries and territories have reported local mosquito-borne Zika transmission, with Brazil by far the hardest hit and the WHO declaring it a public health emergency.
Zika causes only mild symptoms for most people such as fever and a rash, but infected pregnant women can give birth to babies with microcephaly, a deformation marked by abnormally small brains and heads.
– Vaccine concerns –
Scientists had also long been stumped by dengue, which has four separate strains, forcing researchers to find a drug able to fight all of them at once.
Dengue can trigger a crippling fever, along with muscle and joint pain.
But clinical tests on 40,000 people from 15 countries found Dengvaxia can immunize two thirds of people aged nine years and older, rising to 93 percent for the more severe form of the disease, dengue hemorrhagic fever.
It was also found to reduce the risk of hospitalization by 80 percent.
Brazil launched a public immunization program for 500,000 people in Parana in August, while the Philippines has injected 489,000 public school children aged nine since it became in April the first country to use the vaccine.
Philippines health department spokesman Eric Tayag said authorities followed WHO recommendations, which say it should not be given to children under nine years old.
“We are tracking each child” to look for any sign of dengue or side effects, Tayag said.
Some scientists have voiced concerns about studies showing that the vaccine could give dengue to people who have never had the virus.
Scott Halstead, founder of the Pediatric Dengue Vaccine Initiative, told AFP that the WHO was “being hasty” in recommending the vaccine and that people should be tested to see if they have had dengue before being vaccinated.
“It’s not ethical to give a vaccine that harms someone,” Halstead said.
But Leroy noted that Dengvaxia, in addition to the WHO’s green light, is getting approval from government health regulators.
“It is a great solution and the first solution because dengue did not have until now any specific medial solution to treat this illness,” Leroy said, adding that Sanofi is conducting studies in Asia among younger people to see if the vaccine’s reach can expand.
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