Hardship in the Heartland: Associations between Rurality, Income, and Material Hardship

Background: Material hardship (MH) occurs when a household’s consumption of goods and services falls below an acceptable standard (e.g. lack of food, healthcare, transportation, or adequate housing). MH occurs more frequently among households with children and persons of color, and is associated with negative outcomes including harsh parenting and poor mental health. Parents with MH are more likely to experience stress and depression, use physical discipline, and experience child welfare involvement.

Although 30% of US households have experienced MH, only 20% have incomes below $25,000. Despite this discrepancy, researchers do not yet understand how MH is experienced at various income levels. We also do not know how MH and income may intersect in rural areas, as research has not focused on areas with significant rural populations.

Social safety net programs determine eligibility using income, and higher-income households generally do not qualify for food, cash, and housing assistance. Without understanding the relationship between income and MH, safety net programs will continue targeting low-income households, neglecting higher-income households who may also experience MH.

Method: In this descriptive study, we examined associations between income, rurality, and MH using data from a statewide evaluation of healthcare innovations in Iowa, the State Innovation Model (SIM) Statewide Consumer Survey (SCS) (weighted N = 2,371,739). Iowans ages 18 years and older participated in a telephone survey between September 2016 and April 2017.

We hypothesized that rural households would have increased odds for MH than non-rural households, and that lower-income households would incur greater odds for MH than higher-income households. Using binary logistic regression, we investigated odds of transportation, healthcare, food, and any MH by income, rurality, and characteristics including race, age, education, employment, and having children. We conducted ad hoc analysis to examine predicted probabilities for each type of hardship by race, rurality, and income.

Results: MH was common among our sample, with 40% experiencing at least one transportation (15%), healthcare (20%), or food hardship (26%) in the past 12 months. Only 20% reported living in a rural area or subdivision or on a farm. The other 80% lived in towns or cities of <5,000 to 150,000<.

MH was more likely for respondents in non-rural areas, with annual incomes below $50,000, ages 18 to 24, or nonwhite racial status. Contrary to our first hypothesis, rural respondents incurred lower odds of food, transportation, and any hardship, but higher odds of healthcare hardship. All models supported our second hypothesis that lower-income respondents would have greater odds of MH than higher-income respondents.

Predicted probabilities of food, transportation, and any hardship were lower among nonwhite rural residents than white rural residents, demonstrating that rurality may bear more benefit for nonwhite respondents.

Conclusion: Respondents from all demographic groups reported MH, suggesting that MH is not isolated to low-income or other vulnerable groups. Rural living buffered households from MH, particularly for people of color. Our findings have implications for future research and policy makers who establish eligibility guidelines for safety net programs.