024 - U.S. Disability Prevalence by Functional Disability Type, Age, Race, and Insurance Status (2017-2018)

Relevance to ICHPS: This abstract is relevant to contemporary health policy because it provides prevalence estimates and discussion points focused on a population with high healthcare utilization that requires special accommodations to meet their needs and to promote a positive experience with healthcare. The U.S. population analyses presented here lay the groundwork for analyses of healthcare quality, cost, and access in light of contextual policy and environmental factors (e.g., ACA, COVID-19 pandemic).

Intro: Having a disability is often associated with challenges in areas such as education, employment, housing, and healthcare. Specifically, in healthcare, disparities in access, cost, quality, and accessibility among those with disabilities are commonplace. Recent estimates of the prevalence of disability in the U.S. can inform private industry stakeholders, policymakers, and disability advocacy community about the relative frequency of each functional type of disability by important demographic characteristics (e.g., age, sex, race, insurance type). Such awareness will promote increased transparency of potential disparities in this population, guide healthcare stakeholder decision making, and inform advocacy efforts around access, quality, and cost of healthcare.

Methods: Two years of self-report responses (2017-2018) to disability questions from the U.S. Medical Expenditures Panel Survey (MEPS) were analyzed to estimate disability prevalence, overall and by functional type (e.g., Hearing, Seeing, Cognition), among the adult (18+) U.S. population in total and by demographic categories. Complex survey design was utilized to produce weighted prevalence estimates representing the U.S. non-institutionalized population. Crude and age-adjusted prevalence estimates were calculated.

Results: In 2018, approximately 18% (almost 1 in 5) of Americans reported have at least one functional disability, with the most common disabilities being mobility (~10%) and cognitive (~6%) difficulties. Rates of any disability by sex were similar (~19% among females & ~17% among males) and older Americans trended toward higher rates of disability with age (~20% among those 55-64 and >40% among those 65+). By race, White, Black, Multiracial, and American Indian Alaska Native (AIAN) people were relatively comparable in terms of any disability prevalence (ranging between ~17% to ~23%), but Asian Americans had a notably lower prevalence of any disability (~9%). The prevalence of any disability among those with public insurance highest (~37%) and lower among those with any private insurance (~12%) and those who were uninsured (~7%). Prevalence of disability by functional type and insurance type will be presented as well. In general, rates of disability between 2017 and 2018 were remarkably similar.

Discussion: Disability remains a source of healthcare inequities spanning cost, quality, access, and accessibility (either physical or virtual). Given relatively high rates of disability among adults in the U.S. (~1 in 5), healthcare and insurance providers should ensure facilities and services are accessible, disability-competent, and consistent with the health and ability status of the patient population. Disability prevalence may be lowest among the uninsured because of Medicaid's disability eligibility criteria and/or expanded insurance coverage under the ACA for those with disabilities. Future analyses may wish to examine disability prevalence by additional insurance categories, over time (e.g. pre & post ACA), and by state medicaid expansion/waiver status. Pay for performance reimbursement models are increasingly driven by outcomes as measured by quality metrics. Better, more equitable patient outcomes and metrics of quality can be simultaneously achieved if stakeholders collect, monitor, and address not only aggregate measures of quality, but quality among patients with the greatest challenges in accessing and affording healthcare.

Disability

Medical Expenditures Panel Survey (MEPS)

Insurance Status

Complex Survey