22.5% of all households were made up of individuals, and 9.0% had someone living alone who was 65 years of age or older.

[11][circular reference] Many former post offices were, and some current ones are, located along the waterways, which are paralleled by modern roads.

There are also places named in early censuses, some still identifiable today: Ammie, Ashers Fork, Creekville, Deer Lick, Felty, Gardner, Jacks Creek, McWhorter, Portersburg, Queendale, Shepherdtown, Sidell, Spring Creek, Teges, and Trixie.

[13] In the last one hundred years the only Republicans to receive less than sixty percent were Bob Dole, who still won the county by nearly 25 percent, and Barry Goldwater, who held the county by seventy-five votes amidst a Democratic landslide in 1964.

In 2008 John McCain received 77.5% of the vote.,[14] and in 2024 three time GOP nominee Donald Trump posted nearly 90% of Clay's vote, which was the highest total in the county's history.

Clay County also featured prominently in a June 2014 article in The New York Times about the difficulty of living in poverty in eastern Kentucky, ranking last in overall ratings for counties in the United States.

The factors which accounted for Clay county's low ranking were unemployment, prevalence of disabilities, obesity, income, and education.

High rates of smoking and obesity and a low level of physical activity appear to be contributing factors to the lowered longevity for both sexes.