Social Risks Among Adults with Communication Disabilities: Findings from the National Health Interview Survey (2020-2023).

Abstract

To compare the prevalence of health-related social risks (e.g. food insecurity, unreliable transportation) among adults with and without hearing, speaking, and/or understanding difficulties (collectively called communication disabilities (CDs)). Cross-sectional study. Pooled data from the 2020-2023 National Health Interview Survey (NHIS). A nationally representative sample of community dwelling, US adults. Not applicable. Self-reported experience of social risks in food, housing, transportation, and access to medical care due to costs. Separate multivariate logistic regressions with survey weighting were conducted for each social risk factor, adjusted for age, sex, race, ethnicity, health insurance, education, employment, and rurality. Of 118,158 adults, 18.1% reported having a CD including 14.8% with hearing difficulties, 5.3% with difficulty speaking or understanding others, and 2.0% who experienced both. One in three adults with CDs (33.2%) reported at least one social risk, compared to one in four (24.3%) among those without CDs. In adjusted analysis, adults with any CDs had significantly higher rates for all social risks (Risk Difference [RD]: 0.030 to 0.059, P<.001 in all cases). One in three adults with CDs experienced social risks in food insecurity, housing instability, unreliable transportation, and financial barriers to medical care, at rates higher than adults without CDs. The consistency of these findings across multiple social risk domains suggest that structural barriers tied to CD may compound social vulnerability. Findings also underscore opportunities for rehabilitation providers to routinely incorporate social risks into treatment planning as a way to achieve equitable health outcomes for this population.