Cost-Related Healthcare Access Barriers and Unmet Needs among U.S. Adults with Disabilities: A Cross-Sectional Analysis of the 2023 National Health Interview Survey
Chukuigwe Oroma Aleruchi *
Family Medicine, Innovista Medical Center Katy, Texas, USA.
*Author to whom correspondence should be addressed.
Abstract
Background: Adults with disabilities experience persistent barriers to healthcare, but recent national evidence on cost-related delayed and forgone care across disability domains, insurance status, income, and demographic characteristics remains limited. In 2018, approximately 67.5 million U.S. adults (26.0%) had a disability. Despite this substantial population, recent national evidence on how cost-related delays in care and forgone care vary by disability domain, income, and insurance coverage remains limited.
Objective: This study estimated cost-related delayed and forgone care and examined differences by disability domain, insurance coverage, income, and demographic characteristics.
Methods: A cross-sectional analysis of the 2023 National Health Interview Survey included 3,077 complete-case adults with disabilities, representing 23,380,239 adults. Survey-weighted modified Poisson regression estimated adjusted prevalence ratios and 95% confidence intervals. Analyses incorporated sampling weights, strata, and clusters.
Results: Uninsured adults had a higher adjusted prevalence of delayed care (adjusted prevalence ratio [APR] = 2.68, 95% confidence interval [CI]: 2.00 to 3.59) and forgone care (APR = 2.39, 95% CI: 1.74 to 3.28) than insured adults. Residence in the South was associated with delayed care (APR = 2.12, 95% CI: 1.33 to 3.38) and forgone care (APR = 1.76, 95% CI: 1.12 to 2.78). Mobility disability (APR = 1.41, 95% CI: 1.05 to 1.91) and cognitive disability (APR = 1.37, 95% CI: 1.05 to 1.79) were associated with forgone care. Adults at 100% to 199% of the federal poverty level also had a higher prevalence of forgone care (APR = 2.48, 95% CI: 1.53 to 4.01).
Conclusion: Cost-related barriers to care were more common among uninsured adults with disabilities and varied by income, region, and disability domain. Healthcare providers should ask about delayed or forgone care due to cost and connect patients with coverage assistance and affordable care options.
Keywords: Disability, healthcare access, cost-related barriers, unmet healthcare needs, delayed medical care, forgone medical care, health insurance, federal poverty level, national health interview survey