Spokane County (South Central)--Spokane City (South) PUMA, WA

Public Use Microdata Area (PUMA)

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2023 Population

136,423

0.335% 1-year decline

US Senator

Patty Murray

Democratic Party

US Senator

Maria Cantwell

Democratic Party

2023 Median Age

37.6

0.535% 1-year increase

2023 Poverty Rate

15%

1.88% 1-year decrease

2023 Median Household Income

$68,380

3.33% 1-year growth

2023 Median Property Value

$383,400

10.3% 1-year growth

2022 Employed Population

63,057

6.5% 1-year growth

About

In 2023, Spokane County (South Central)--Spokane City (South) PUMA, WA had a population of 136k people with a median age of 37.6 and a median household income of $68,380. Between 2022 and 2023 the population of Spokane County (South Central)--Spokane City (South) PUMA, WA declined from 136,881 to 136,423, a −0.335% decrease and its median household income grew from $66,174 to $68,380, a 3.33% increase.

The 5 largest ethnic groups in Spokane County (South Central)--Spokane City (South) PUMA, WA are White (Non-Hispanic) (78.7%), Two+ (Non-Hispanic) (6.01%), Asian (Non-Hispanic) (2.99%), Two+ (Hispanic) (2.89%), and Black or African American (Non-Hispanic) (2.77%).

8.46% of the households in Spokane County (South Central)--Spokane City (South) PUMA, WA reported speaking a non-English language at home as their primary shared language. This does not consider the potential multi-lingual nature of households, but only the primary self-reported language spoken by all members of the household.

97% of the residents in Spokane County (South Central)--Spokane City (South) PUMA, WA are U.S. citizens.

The largest universities in Spokane County (South Central)--Spokane City (South) PUMA, WA are Gonzaga University (2,174 degrees awarded in 2022), Spokane Community College (1,969 degrees), and Spokane Falls Community College (1,248 degrees).

In 2023, the median property value in Spokane County (South Central)--Spokane City (South) PUMA, WA was $383,400, and the homeownership rate was 55.4%.

Most people in Spokane County (South Central)--Spokane City (South) PUMA, WA drove alone to work, and the average commute time was 19.7 minutes. The average car ownership in Spokane County (South Central)--Spokane City (South) PUMA, WA was 2 cars per household.

Spokane County (South Central)--Spokane City (South) PUMA, WA borders Spokane County (Outer)--Cheney City PUMA, WA, Spokane County (East Central)--Greater Spokane Valley City PUMA, WA, and Spokane County (North Central)--Spokane City (North) PUMA, WA.

United States Washington

Population & Diversity

Spokane County (South Central)--Spokane City (South) PUMA, WA is home to a population of 136k people, from which 97% are citizens. As of 2023, 6.08% of Spokane County (South Central)--Spokane City (South) PUMA, WA residents were born outside of the country (8.29k people).

In 2023, there were 13.1 times more White (Non-Hispanic) residents (107k people) in Spokane County (South Central)--Spokane City (South) PUMA, WA than any other race or ethnicity. There were 8.2k Two+ (Non-Hispanic) and 4.08k Asian (Non-Hispanic) residents, the second and third most common ethnic groups.

The most common non-English languages spoken as the primary langauge in households in Spokane County (South Central)--Spokane City (South) PUMA, WA are Spanish (3,654 households), Russian (1,082 households), and Arabic (754 households).

Population & Diversity

Residents by Gender and Age

RACE/ETHNICITY

68,498

Women

50.3%

67,707

Men

49.7%

The resident population of United States in 2022 was 136,205 inhabitants, with 49.7% men, and 50.3% women.

The visualization shows the distribution of the residents by gender and age in the United States.

With the upper buttons you can add a filter by race.

Citizenship

97%

2023 Citizenship

97.3%

2022 Citizenship

As of 2023, 97% of Spokane County (South Central)--Spokane City (South) PUMA, WA residents were US citizens, which is higher than the national average of 93.4%. In 2022, the percentage of US citizens in Spokane County (South Central)--Spokane City (South) PUMA, WA was 97.3%, meaning that the rate of citizenship has been decreasing.

The following chart shows US citizenship percentages in Spokane County (South Central)--Spokane City (South) PUMA, WA compared to that of it's neighboring and parent geographies.

Diversity

Race and Ethnicity

The 3 largest ethnic groups in Spokane County (South Central)--Spokane City (South) PUMA, WA

White (Non-Hispanic)
107k ± 2.7k
Two+ (Non-Hispanic)
8.2k ± 798
Asian (Non-Hispanic)
4.08k ± 694

7.64%

Hispanic Population

10.4k people

7.64% of the people in Spokane County (South Central)--Spokane City (South) PUMA, WA are hispanic (10.4k people).

The following chart shows the 7 races represented in Spokane County (South Central)--Spokane City (South) PUMA, WA as a share of the total population.

Global Diversity

Most Common Origin

Iraq
844 ± 711 people
Ukraine
747 ± 669 people
Mexico
704 ± 650 people

In 2022, the most common birthplace for the foreign-born residents of Spokane County (South Central)--Spokane City (South) PUMA, WA was Iraq, the natal country of 844 Spokane County (South Central)--Spokane City (South) PUMA, WA residents, followed by Ukraine with 747 and Mexico with 704.

Foreign-Born Population

6.08%

2023 Foreign-Born Population

8.29k people

5.52%

2022 Foreign-Born Population

7.55k people

As of 2023, 6.08% of Spokane County (South Central)--Spokane City (South) PUMA, WA residents (8.29k people) were born outside of the United States, which is lower than the national average of 13.8%. In 2022, the percentage of foreign-born citizens in Spokane County (South Central)--Spokane City (South) PUMA, WA was 5.52%, meaning that the rate has been increasing.

The following chart shows the percentage of foreign-born residents in Spokane County (South Central)--Spokane City (South) PUMA, WA compared to that of it's neighboring and parent geographies.

Non-English Households

Most Common Non-English Languages

Spanish
3,654 households (2.82%)
Russian
1,082 households (0.835%)
Arabic
754 households (0.582%)

8.46% of the households in Spokane County (South Central)--Spokane City (South) PUMA, WA reported speaking a non-English language at home as their primary shared language, which is lower than the national average of 22%. This does not consider the potential multi-lingual nature of households, but only the primary self-reported language spoken by all members of the household.

In 2023, the most common non-English language spoken in households in Spokane County (South Central)--Spokane City (South) PUMA, WA was Spanish. 2.82% of the households in Spokane County (South Central)--Spokane City (South) PUMA, WA reported speaking Spanish at home as the primary shared language between all members living in the household.

Military

Veterans

Most Common Service Period

Vietnam
3,199 ± 387
Gulf War (2001-)
2,509 ± 422
Gulf War (1990s)
1,595 ± 360

Spokane County (South Central)--Spokane City (South) PUMA, WA has a large population of military personnel who served in Vietnam, 1.28 times greater than any other conflict.

Economy

The economy of Spokane County (South Central)--Spokane City (South) PUMA, WA employs 63.1k people. The largest industries in Spokane County (South Central)--Spokane City (South) PUMA, WA are Restaurants & Food Services (4,316 people), General medical and surgical hospitals, and specialty (except psychiatric and substance abuse) hospitals (3,531 people), and Elementary & secondary schools (3,207 people), and the highest paying industries are Nonmetallic mineral mining & quarrying ($399,847), Offices of physicians ($177,708), and Internet publishing, broadcasting & web search portals ($170,540).

Males in Spokane County (South Central)--Spokane City (South) PUMA, WA have an average income that is 1.28 times higher than the average income of females, which is $65,730. The income inequality in Spokane County (South Central)--Spokane City (South) PUMA, WA (measured using the Gini index) is 0.485, which is higher than than the national average.

Employment

Workforce Diversity

Measure

RACE/ETHNICITY

27,777

Women

48.5%

29,476

Men

51.5%

The workforce of Spokane County (South Central)--Spokane City (South) PUMA, WA in 2020 was 57,253 people, with 48.5% woman, and 51.5% men.

The visualization shows the distribution of the workforce by gender and age in Spokane County (South Central)--Spokane City (South) PUMA, WA.

With the upper buttons you can see the distribution of the average salary and add a filter by race.

Occupations

63.1k

2022 Value

6.5%

1 Year growth

± 6.5%

From 2021 to 2022, employment in Spokane County (South Central)--Spokane City (South) PUMA, WA grew at a rate of 6.5%, from 59.2k employees to 63.1k employees.

The most common job groups, by number of people living in Spokane County (South Central)--Spokane City (South) PUMA, WA, are Registered nurses (1,547 people), Other managers (1,408 people), and Customer service representatives (1,375 people). This chart illustrates the share breakdown of the primary jobs held by residents of Spokane County (South Central)--Spokane City (South) PUMA, WA.

Unemployment Insurance Claims

Data is only available at the state level. Showing data for false.

This chart shows weekly unemployment insurance claims in Washington (not-seasonally adjusted) compared with the four states with the most similar impact.

The most recent data point uses Advance State Claims data, which can be revised in subsequent weeks.

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Industries

Employment by Industries

63.1k

2022 Value

6.5%

1 Year growth

± 6.5%

From 2021 to 2022, employment in Spokane County (South Central)--Spokane City (South) PUMA, WA grew at a rate of 6.5%, from 59.2k employees to 63.1k employees.

The most common employment sectors for those who live in Spokane County (South Central)--Spokane City (South) PUMA, WA, are Restaurants & Food Services (4,316 people), General medical and surgical hospitals, and specialty (except psychiatric and substance abuse) hospitals (3,531 people), and Elementary & secondary schools (3,207 people). This chart shows the share breakdown of the primary industries for residents of Spokane County (South Central)--Spokane City (South) PUMA, WA, though some of these residents may live in Spokane County (South Central)--Spokane City (South) PUMA, WA and work somewhere else. Census data is tagged to a residential address, not a work address.

Median Earnings by Industry

$54,128

Median earning men ± $2,424

$42,085

Median earning women ± $1,499

The industries with the best median earnings for men in 2023 are Information ($87,569), Finance & Insurance, & Real Estate & Rental & Leasing ($86,671), and Public Administration ($80,757).

The industries with the best median earnings for women in 2023 are Public Administration ($65,915), Wholesale Trade ($63,021), and Finance & Insurance, & Real Estate & Rental & Leasing ($59,349).

Employment by Industry Sector

Data is only available at the state level. Showing data for Washington.

Y-Axis

3.62%

Year-over-year growth

Employment change between February 2022 and February 2023

As of February 2023, there are 3.58M people employed in Washington. This represents a 3.62% increase in employment when compared to February 2022.

Right after the beginning of the COVID-19 pandemic, during April 2020, a general dip can be seen across industry sectors, resulting in an overall decline in employment by 10.3%.

The following chart shows monthly employment numbers for each industry sector in Washington.

Civics

In the 2024 presidential election, the popular vote in Washington went to Kamala Harris with 57.2% of the vote. The runner-up was Donald J. Trump (39%), followed by Robert Kennedy (1.4%).

Patty Murray and Maria Cantwell are the senators currently representing the state of Washington. In the United States, senators are elected to 6-year terms with the terms for individual senators staggered.

Washington is currently represented by 10 members in the U.S. house, and members of the House of Representives are elected to 2-year terms.

Presidential Elections

Presidential Popular Vote Over Time

Voting results are not available for Spokane County (South Central)--Spokane City (South) PUMA, WA. Showing the available data for Washington.

2024 Election Results

Kamala Harris (57.2%)
Democratic Party
Donald J. Trump (39%)
Republican Party
Robert Kennedy (1.4%)
Independent Party

In the 2024 presidential election, the popular vote in Washington went to Kamala Harris with 57.2% of the vote. The runner-up was Donald J. Trump (39%), followed by Robert Kennedy (1.4%).

The following chart shows the popular vote results in Washington for each registered party from 1976 to 2024.

Senator Elections

US Senators from Washington

Senatorial voting results are only available at the state level. Showing data for Washington.

Patty Murray

Senator from Washington

Assumed office on January 3, 1993

Maria Cantwell

Senator from Washington

Assumed office on January 3, 2001

Patty Murray and Maria Cantwell are the senators currently representing Washington.

In the United States, senators are elected to 6-year terms with the terms for individual senators staggered.

The following chart shows elected senators in Washington over time, excluding special elections, colored by their political party.

US Representative Elections

US Representatives from Washington

Washington is currently represented by 10 members in the U.S. house.

Members of the House of Representives are elected to 2-year terms, and the following chart shows the how the members for Washington have changed over time starting in 2008.

Education

In 2022, universities in Spokane County (South Central)--Spokane City (South) PUMA, WA awarded 5,496 degrees. The student population of Spokane County (South Central)--Spokane City (South) PUMA, WA in 2022 is skewed towards women, with 7,417 male students and 10,303 female students.

Most students graduating from Universities in Spokane County (South Central)--Spokane City (South) PUMA, WA are White (3,902 and 72.7%), followed by Hispanic or Latino (464 and 8.64%), Unknown (335 and 6.24%), and Two or More Races (298 and 5.55%).

The largest universities in Spokane County (South Central)--Spokane City (South) PUMA, WA by number of degrees awarded are Gonzaga University (2,174 and 39.6%), Spokane Community College (1,969 and 35.8%), and Spokane Falls Community College (1,248 and 22.7%).

The most popular majors in Spokane County (South Central)--Spokane City (South) PUMA, WA are Liberal Arts & Sciences (1,152 and 21%), General Business (389 and 7.08%), and Automobile Mechanics Technology (355 and 6.46%).

The median tuition costs in Spokane County (South Central)--Spokane City (South) PUMA, WA are $33,150 for private four year colleges, and $3,102 and $3,970 respectively, for public four year colleges for in-state students and out-of-state students.

Admissions & Enrollments

Applicants, Admissions & Enrolled

University

Measure

In 2022 in Spokane County (South Central)--Spokane City (South) PUMA, WA, the percentage of applicants admitted was 69.8%, while the percentage of admitted who enrolled was 17.9%. The number of students enrolled in 2022 was 17,720 (41.9% men and 58.1% women).

The line chart shows the evolution of the percentage of applicants admitted, admitted who enrolled or the number of students enrolled according to the option selected in the upper button.

Enrollments by Gender and Races

Universities

In 2022 there were 17,720 students enrolled in Spokane County (South Central)--Spokane City (South) PUMA, WA, 41.9% men and 58.1% women.

By race, the largest number of students enrolled was concentrated in White with 11,055 records, of which 58.8% were women and 41.2% men.

Completions

Concentrations

Most Common

Liberal Arts & Sciences
1,152 degrees awarded
Registered Nursing
76 degrees awarded
General Business
52 degrees awarded

In 2022, the most common concentation for Associates Degree recipients in Spokane County (South Central)--Spokane City (South) PUMA, WA was Liberal Arts & Sciences with 1,152 degrees awarded.

This visualization illustrates the percentage of students graduating with a Associates Degree from schools in Spokane County (South Central)--Spokane City (South) PUMA, WA according to their major.

Universities

Gender

Race

Largest Universities by degrees awarded

Gonzaga University
2,174 degrees awarded
Spokane Community College
1,969 degrees awarded
Spokane Falls Community College
1,248 degrees awarded

In 2022, the institution with the largest number of graduating students was Gonzaga University with 2,174 degrees awarded.

Student Diversity

University

In 2022, 2,329 men were awarded degrees from institutions in Spokane County (South Central)--Spokane City (South) PUMA, WA, which is 0.735 times less than the 3,167 female students who received degrees in the same year.

In 2022 the most common race/ethnicity group awarded degrees at institutions was White students. These 3,902 degrees mean that there were 8.41 times more degrees awarded to White students then the next closest race/ethnicity group, Hispanic or Latino, with 464 degrees awarded.

Awarded Degrees over Time

The graph shows the evolution of awarded degrees by degrees. Under the paragraphs, the average number of awarded degrees by university in each degree is shown.

Tuition

Average Net Price by Sector

Universities

Private not-for-profit, 4-year or above ($33,150) is the sector with the highest median state tuition in 2022.

Private not-for-profit, 4-year or above ($935) is the sector with the highest median state fee in 2022.

Public, 4-year or above ($1,134) is the sector with the highest average net price of books and supplies.

The graph shows the average net price by sector and year.

Working Population

Educational Pyramid

Measure

In 2022, 0.936% of men over 25 years of age had not completed any academic degree (no schooling), while 0.407% of women were in the same situation.

This visualization shows the gender distribution of the population according to the academic level reached.

Educational Attainment

Race

The most common educational levels obtained by the working population of Spokane County (South Central)--Spokane City (South) PUMA, WA in 2022 were Some college (29.5k), Bachelors Degree (24.9k), and High School or Equivalent (22.6k).

This visualization illustrates the percentage distribution of the population according to the highest educational level reached. You can filter the data by race by using the selector above.

Housing & Living

The median property value in Spokane County (South Central)--Spokane City (South) PUMA, WA was $383,400 in 2023, which is 1.26 times larger than the national average of $303,400. Between 2022 and 2023 the median property value increased from $347,500 to $383,400, a 10.3% increase. The homeownership rate in Spokane County (South Central)--Spokane City (South) PUMA, WA is 55.4%, which is approximately the same as the national average of 65%.

People in Spokane County (South Central)--Spokane City (South) PUMA, WA have an average commute time of 19.7 minutes, and they drove alone to work. Car ownership in Spokane County (South Central)--Spokane City (South) PUMA, WA is approximately the same as the national average, with an average of 2 cars per household.

Median household income in Spokane County (South Central)--Spokane City (South) PUMA, WA is $68,380. In 2023, the PUMA with the highest Median Household Income in Spokane County (South Central)--Spokane City (South) PUMA, WA was King County (Central)--Sammamish, Issaquah, Mercer Island & Newcastle Cities PUMA, WA with a value of $192,778, followed by King County (Northeast)--Snoqualmie City, Cottage Lake, Union Hill & Novelty Hill PUMA, WA and King County (Northwest Central)--Greater Bellevue City PUMA, WA, with respective values of $175,297 and $163,708.

Housing

Property

$383,400

Median Property Value 2023

±$8,940

$32,781

Median Property Taxes

±$1,302

The following chart display owner-occupied housing units distributed between a series of property tax buckets compared to the national averages for each bucket. In Spokane County (South Central)--Spokane City (South) PUMA, WA the largest share of households pay taxes in the $3k+ range.

The chart underneath the paragraph shows the property taxes in Spokane County (South Central)--Spokane City (South) PUMA, WA compared to it's parent and neighbor geographies.

Rent vs Own

55.4%

Homeownership

2023

67.4%

Homeowners with Mortgage

2023

In 2023, 55.4% of the housing units in Spokane County (South Central)--Spokane City (South) PUMA, WA were occupied by their owner. This percentage grew from the previous year's rate of 54.5%.

This chart shows the percentage of owner in Spokane County (South Central)--Spokane City (South) PUMA, WA compared it's parent and neighboring geographies.

Equity

Income by Location

Use the dropdown to filter by race/ethnicity.

Race/Ethnicity

Highest Median Household Income (Total)

In 2023, the PUMA with the highest Median Household Income (Total) in Spokane County (South Central)--Spokane City (South) PUMA, WA was King County (Central)--Sammamish, Issaquah, Mercer Island & Newcastle Cities PUMA, WA with a value of $192,778, followed by King County (Northeast)--Snoqualmie City, Cottage Lake, Union Hill & Novelty Hill PUMA, WA and King County (Northwest Central)--Greater Bellevue City PUMA, WA, with respective values of $175,297 and $163,708.

The following map shows all of the PUMAs in Spokane County (South Central)--Spokane City (South) PUMA, WA colored by their Median Household Income (Total).

Household Income

Please note that the buckets used in this visualization were not evenly distributed by ACS when publishing the data.

$68,380

Median Household Income

± $1,787

59.1k

Number of Households

± 1,905

In 2023, the median household income of the 59.1k households in Spokane County (South Central)--Spokane City (South) PUMA, WA grew to $68,380 from the previous year's value of $66,174.

The following chart displays the households in Spokane County (South Central)--Spokane City (South) PUMA, WA distributed between a series of income buckets compared to the national averages for each bucket. The largest share of households have an income in the $75k - $100k range.

Wage Distribution

0.485

2022 Wage GINI in Spokane County (South Central)--Spokane City (South) PUMA, WA

0.488

2021 Wage GINI in Spokane County (South Central)--Spokane City (South) PUMA, WA

In 2022, the income inequality in Spokane County (South Central)--Spokane City (South) PUMA, WA was 0.485 according to the GINI calculation of the wage distribution. Income inequality had a 0.641% decline from 2021 to 2022, which means that wage distribution grew somewhat more even. The GINI for Spokane County (South Central)--Spokane City (South) PUMA, WA was higher than than the national average of 0.478. In other words, wages are distributed less evenly in Spokane County (South Central)--Spokane City (South) PUMA, WA in comparison to the national average.

This chart shows the number of workers in Spokane County (South Central)--Spokane City (South) PUMA, WA across various wage buckets compared to the national average.

Transportation

Commuter Transportation

Most Common Commute in 2023

Drove Alone (66.2%)
Worked At Home (16%)
Carpooled (8.85%)

In 2023, 66.2% of workers in Spokane County (South Central)--Spokane City (South) PUMA, WA drove alone to work, followed by those who worked at home (16%) and those who carpooled to work (8.85%).

The following chart shows the number of households using each mode of transportation over time, using a logarithmic scale on the y-axis to help better show variations in the smaller means of commuting.

Commute Time

19.7 minutes

Average Travel Time

Using averages, employees in Spokane County (South Central)--Spokane City (South) PUMA, WA have a shorter commute time (19.7 minutes) than the normal US worker (26.6 minutes). Additionally, 1.56% of the workforce in Spokane County (South Central)--Spokane City (South) PUMA, WA have "super commutes" in excess of 90 minutes.

The chart below shows how the median household income in Spokane County (South Central)--Spokane City (South) PUMA, WA compares to that of it's neighboring and parent geographies.

Car Ownership

2 cars

Average Number

The following chart displays the households in Spokane County (South Central)--Spokane City (South) PUMA, WA distributed between a series of car ownership buckets compared to the national averages for each bucket. The largest share of households in Spokane County (South Central)--Spokane City (South) PUMA, WA have 2 cars.

Poverty

Poverty & Diversity

15% of the population for whom poverty status is determined in Spokane County (South Central)--Spokane City (South) PUMA, WA (19.8k out of 132k people) live below the poverty line, a number that is higher than the national average of 12.4%. The largest demographic living in poverty are Males 18 - 24, followed by Females 25 - 34 and then Females 18 - 24.

The most common racial or ethnic group living below the poverty line in Spokane County (South Central)--Spokane City (South) PUMA, WA is White, followed by Two Or More and Hispanic.

The Census Bureau uses a set of money income thresholds that vary by family size and composition to determine who classifies as impoverished. If a family's total income is less than the family's threshold than that family and every individual in it is considered to be living in poverty.

Social Needs

Data only available at the state level.

Most prevalent states

California
35,798 individuals
New York
5,087 individuals
Florida
4,915 individuals

In 2017, California had the highest estimated number of chronically homeless individuals in the nation, at 35,798. New York has the second highest (5,087), followed by Florida (4,915).

The following map shows the estimated number of chronically homeless individuals by state over multiple years.

Health

95.2% of the population of Spokane County (South Central)--Spokane City (South) PUMA, WA has health coverage, with 46.4% on employee plans, 21.3% on Medicaid, 12% on Medicare, 13.2% on non-group plans, and 2.25% on military or VA plans.

Primary care physicians in Washington see 1184 patients per year on average, which represents a 0.68% increase from the previous year (1176 patients). Compare this to dentists who see 1175 patients per year, and mental health providers who see 215 patients per year.

Coverage

Patient to Clinician Ratios

Data is only available at the state level. Showing data for Washington.

1,184 to 1

Patient to Primary Care Physician Ratio in Washington

Primary care physicians in Washington see an average of 1,184 patients per year. This represents a 0.68% increase from the previous year (1,176 patients).

The following chart shows how the number of patients seen by primary care physicians has been changing over time in Washington in comparison to its neighboring geographies.

Health Care Diversity

In 2023, insured persons according to age ranges were distributed in 20.5% under 18 years, 25.5% between 18 and 34 years, 37% between 35 and 64 years, and 16.9% over 64 years.

By gender, of the total number of insured persons, 48.5% were men and 51.5% were women.

The following chart shows the number of people with health coverage by gender.

Uninsured People

4.83%

Uninsured

46.4%

Employer Coverage

21.3%

Medicaid

12%

Medicare

13.2%

Non-Group

2.25%

Military or VA

Between 2022 and 2023, the percent of uninsured citizens in Spokane County (South Central)--Spokane City (South) PUMA, WA grew by 1.03% from 4.78% to 4.83%.

The following chart shows how the percent of uninsured individuals in Spokane County (South Central)--Spokane City (South) PUMA, WA changed over time compared with the percent of individuals enrolled in various types of health insurance.