Disabled and left behind: U.S. poor housing through a social determinants of health lens

Background: Social determinants of health (SDOH), the conditions in which people live, work, play, and learn, are largely responsible for health inequities seen among individuals with disabilities. However, less is known about relationships between SDOH and poor housing for disabled adults. Using state-level SDOH proxy variables for economic stability, education, healthcare access, and the social and community context, this secondary data analysis examined the interrelated effects of SDOH proxy variables on poor housing for disabled adults in the United States. Design and methods: We used quantitative comparison and regression analysis of national, state-level estimates from the 2023 Annual Disability Statistics Compendium and 2021 American Community Survey data to investigate poor housing outcomes for disabled adults. We intentionally examine state-level estimates of prevalence rates, rather than individual-level data, to better understand the systemic nature of SDOH relationships for disabled adults. Results: Compared to non-disabled adults, a higher percentage of disabled adults reside in poor housing, have lower state-level employment rates, have higher rates of high school-only education, lower rates of 4-year college degrees, and have lower voter turnout. SDOH proxy variables of employment and education were consistently strong predictors of state-level poor housing for both disabled and non-disabled adults. When all four SDOH proxy variables were included in the regression analysis, they accounted for 62.6% and 62.7% of the variability in state-level poor housing for disabled and non-disabled adults, respectively. Conclusions: Findings suggest that including SDOH domains provides a robust model for understanding housing challenges for both disabled and non-disabled adults.