Disability and the household context: Findings for the United States from the public Use Microdata Sample of the American Community Survey.

Introduction: Based on questions about impairments and activity limitations, the American Community Survey shows that roughly 13% of the U.S. population is experiencing disability. As most people live in households with other persons, this study explores disability at the household level. Considering the literature on household decision-making, solidarity, and capabilities in disability, this analysis of the household context of disability takes into account residential settings, household composition, and urban-rural differences. Method: The 2015-2019 ACS Public Use Microdata Sample (PUMS), which shows persons with disability (PwD) and persons without disability (PwoD), also indicates household membership, used here to separately identify PwoD as those living in households with persons with disability (PwoD_HHwD) and those in households without any household member with disability (PwoD_HHwoD). Relationship variables reveal the composition of households with and without disabilities. An adaption of Beale's rural-urban continuum code for counties is used to approximate rural-urban differences with ACS PUMS data. Results: Solo living is two times as common among persons with disability than among persons without disability, and higher in rural than urban areas. In addition to 43 million PwD, there are another 42 million PwoD_HHwD. Two times as many persons are impacted by disability, either of their own or that of a household member, than shown by an analysis of individual-level disability. For family households, differences in the composition of households with and without disabilities are considerable with much greater complexities in the makeup of families with disability. The presence of multiple generations stands out. Adult sons or daughters without disability play an important role. Modest urban-rural differences exist in the composition of family households with disability, with a greater presence of multigenerational households in large cities. Discussion: This research reveals the much wider scope of household-level disability than indicated by disability of individuals alone. The greater complexity and multigenerational makeup of households with disability imply intergenerational solidarity, reciprocity, and resource sharing. Household members without disability may add to the capabilities of persons with disabilities. For the sizeable share of PwD living solo, there is concern about their needs being met.