Knox County, Tennessee
More than double the national median of residents with medical debt in collections.
Main Findings
Knox County, Tennessee ranks 1,241st most distressed in the United States on the County Distress Index. The driver: 8% of residents with a credit file carry medical debt in collections — more than double the national median of 4%.
- 1,241st of 3,144 counties on the County Distress Index — Elevated zone, 65th in Tennessee.
- 8% of residents with a credit file carry medical debt in collections (U.S. median 4%). Medical debt in collections at the 84th percentile nationally.
- Homeownership rate at 65% — national median 74%, ranked at the 85th percentile.
- Bankruptcy filing rate at 161 — national median 126, ranked at the 63rd percentile.
- Rent-to-income ratio at 25% — national median 21%, ranked at the 80th percentile.
Neighbors span two CDI zones. The 17-point drop to Loudon County marks where the Tennessee distress corridor ends.
"Knox County is where distress lives in the margins. A county where most households are running out of runway, even as the headline numbers stay quiet."
"Elevated-zone counties are the largest block in the index. Most Americans live in counties scoring 55–70 — middle-class households doing the math every month."
The Indicators Behind Knox County's CDI Score
Every number traces to a public source. Knox County's value shown alongside TN's median and the U.S. median. Full CSV available for download.
| Indicator | Knox | TN median | U.S. median | Pctile | Source |
|---|---|---|---|---|---|
| Consumer Credit Distress — domain score 52 · Rank 1,477 of 3,144 | |||||
| Debt in collections Share of residents with a credit file who have debt in collections | 24% | 28% | 23% | 53rd | Urban Institute (2024) |
| Medical debt in collections Share of residents with a credit file who have medical debt in collections | 8% | 8% | 4% | 84th | Urban Institute (2024) |
| Auto loan delinquency Share of auto loan accounts 60+ days past due | 5% | 6% | 5% | 51st | Urban Institute (2024) |
| Credit card delinquency Share of credit card accounts 60+ days past due | 5% | 6% | 5% | 37th | Urban Institute (2024) |
| Uninsured rate Share of residents without health insurance coverage | 8% | 10% | 8% | 53rd | Census ACS 5-yr (2023) |
| Subprime credit share Share of residents with a credit score below 660 | 22% | 26% | 23% | 44th | Urban Institute (2024) |
| Housing Cost Burden — domain score 77 · Rank 479 of 3,144 | |||||
| Rent burden (30%+) Share of renter households paying 30%+ of income on rent | 46% | 35% | 38% | 83rd | Census ACS 5-yr (2023) |
| Severe rent burden (50%+) Share of renter households paying 50%+ of income on rent | 22% | 17% | 18% | 77th | Census ACS 5-yr (2023) |
| Owner housing burden Share of owner households paying 30%+ of income on housing | 24% | 22% | 24% | 52nd | Census ACS 5-yr (2023) |
| Homeownership rate Share of occupied housing units that are owner-occupied | 65% | 75% | 74% | 85th | Census ACS 5-yr (2023) |
| Structural Poverty — domain score 23 · Rank 2,651 of 3,144 | |||||
| Unemployment Share of labor force unemployed | 3% | 4% | 4% | 9th | BLS LAUS (Dec 2025) |
| Poverty rate Share of population below the federal poverty line | 14% | 16% | 14% | 52nd | Census SAIPE (2023) |
| Household income relative to state Median household income as share of state median | 1.22× | 1.00× | 1.00× | 15th | Census SAIPE (2023) |
| Child poverty rate Share of children under 18 below the federal poverty line | 16% | 21% | 18% | 39th | Census SAIPE (2023) |
| Disability rate Share of residents reporting a disability | 12% | 19% | 16% | 19th | Census ACS 5-yr (2023) |
| Transfer-income dependency Share of personal income from government transfers | 17% | 30% | 27% | 11th | BEA Regional Personal Income (2023) |
| Legal Distress — domain score 63 · Rank 1,151 of 3,144 | |||||
| Bankruptcy filing rate Personal bankruptcy filings per 100,000 residents | 161 | 216 | 126 | 63rd | US Courts F-5A (2025) |
| Economic Vitality — domain score 61 · Rank 937 of 3,144 | |||||
| Wage-to-rent ratio Ratio of average weekly wage to fair-market rent | 3.7× | 4.1× | 4.0× | 66th | BLS QCEW × HUD FMR (2024) |
| Rent-to-income ratio Fair Market Rent (2BR) as share of median household income | 25% | 22% | 21% | 80th | HUD FMR × Census ACS (2024) |
| Business formation rate New business applications per 1,000 residents | 14.2 | 8.1 | 10.0 | 19th | Census Business Formation Statistics (2024) |
| House price change (yoy) House price index year-over-year change | 3% | 4% | 4% | 60th | FHFA HPI (2024) |
Five-Domain Breakdown
The CDI is a PCA-weighted composite of five statistically derived factors. Weights are proportional to each factor's share of explained variance across 3,144 counties.
Methodology
The County Distress Index is a 0–100 composite score of household financial distress, computed for all 3,144 U.S. counties. A score of 50 represents the national county median; higher scores indicate greater distress. The index is built from 21 indicators grouped into five statistically derived factors via principal component analysis (PCA); factor weights are proportional to each factor's share of explained variance (shown in the Five-Domain Breakdown above).
Data sources include the Urban Institute Debt in America (Equifax consumer credit panel), U.S. Census Bureau (American Community Survey 5-year, Small Area Income and Poverty Estimates, Business Formation Statistics), Bureau of Labor Statistics (Local Area Unemployment Statistics, Quarterly Census of Employment and Wages), U.S. Courts Administrative Office (F-5A bankruptcy filings), and HUD Fair Market Rents. Data vintages range from 2023 to 2025 depending on source; full indicator-level vintage detail is in the methodology document.
For Press & Research
Everything you need to cite Knox County data — in under 60 seconds.
Draft wire copy 155-word AP-style article — use freely with attribution
KNOXVILLE, Tenn. — Knox County ranks 1,241st among the nation's most financially distressed counties, according to the County Distress Index released this month by American Default Research.
The composite score of 55 out of 100 places Knox in the "Elevated" zone. Among 3,144 U.S. counties scored, 1,240 counties rank more distressed. Within Tennessee, Knox ranks 65th of 95 counties.
The index, which draws on 21 indicators from the U.S. Census Bureau, Bureau of Labor Statistics, Urban Institute and federal court filings, identifies consumer credit distress as the primary driver in Knox. 8% of residents with a credit file carry medical debt in collections — more than double the national median of 4%.
"Knox County is where distress lives in the margins. A county where most households are running out of runway, even as the headline numbers stay quiet," said Ross Kilburn, founder of American Default Research.
Full methodology and county-by-county data are available at americandefault.org/methodology/cdi.
Frequently Asked Questions
What is Knox County's CDI score, and what does it mean?
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How is the County Distress Index calculated?
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