Available online 19 July 2025, 101930

Few studies have quantified the higher cost of living with a disability and the extent of unmet needs for disability-related goods and services as experienced by adults with disabilities in the U.S.

To provide national estimates of total annual out-of-pocket disability-related expenditures, their burden, and the prevalence of unmet needs, and to investigate whether persons with disabilities from underserved communities experience disparate impacts from “the disability squeeze.”

We designed and fielded a survey in June of 2023 to a nationally representative sample of adults with disabilities through the Understanding America Study, an online panel survey. Multivariate regression analyses examine correlates with out-of-pocket expenditures, the financial burden of the expenditures, and unmet needs.

Among 1168 working-age adults with disabilities, mean annual expenditures on disability-related goods and services was $5341 in June 2023, equating to 20 % of household income. Additionally, 67 % of adults with disabilities reported an unmet need. Controlling for sociodemographic characteristics, adults with disabilities with incomes below the federal poverty level reported significantly lower expenditures (p < .05) but greater financial burden from their out-of-pocket expenses (p < .05). Hispanic persons with disabilities also reported significantly lower expenditures (p < .05) but higher rates of unmet need (p < .05).

Adults with disabilities in the U.S. experience considerable financial strain from their disability-related expenses and sustain high rates of unmet needs with disproportionate impacts identified for those from underserved communities.

Extra costs of disability

Poverty

Disability policy

Financial inclusion

© 2025 The Authors. Published by Elsevier Inc.