Disability Diagnoses Identified by the American Community Survey 6-Question Sequence.

Importance: Federal survey data collection identifies people with disabilities predominantly by using a 6-question sequence asking about different functional impairments known as the American Community Survey-6 (ACS-6). However, little is known about the specific diagnoses identified by the ACS-6 or whether they vary across demographic subgroups. Objective: To characterize the disability diagnoses identified by the ACS-6 and assess to what extent they identify a consistent population across demographic subgroups. Design, Setting, and Participants: This cross-sectional study among people with disabilities responding to the 2023 or 2024 Survey of Income and Program Participation (SIPP) assessed the prevalence of 36 different diagnosis groupings in the ACS-6 as a whole and within each of the individual questions, as well as how the identified diagnoses varied by age group, race and ethnicity, sex, and educational attainment, with further disaggregation by cognitive disability status. Data were analyzed between August 1 and September 15, 2025. Exposure: Identification as people with disabilities using the ACS-6. Main Outcomes and Measures: Diagnoses reported by survey respondents as causing the functional impairments they listed in the SIPP. Results: A total of 13 341 people with disabilities (52.2% female; mean [SD] age, 53.0 [23.0] years) responding to the SIPP were included. Among people with disabilities aged 22 to 64 years, the most common diagnoses were anxiety or obsessive-compulsive disorders (prevalence, 15.6%; 95% CI, 14.5%-16.9%), depression (15.3%; 95% CI, 14.1%-16.5%), unspecified musculoskeletal issues (13.5%; 95% CI, 12.5%-14.6%), back or spinal problems (11.6%; 95% CI, 10.6%-12.6%), and unspecified neurologic disorders (10.8%; 95% CI, 9.8%-11.8%). The most common disability diagnoses reported by respondents identified by the ACS-6 were different across age groups but similar across demographic groups defined by sex, race and ethnicity, and educational attainment. Conclusions and Relevance: The results of this cross-sectional study suggest that the ACS-6 identifies a similar population across demographic subgroups not characterized by age but highlight substantial heterogeneity in the population of people with disabilities within these subgroups and across age groups. Contemporary debates regarding future revisions to disability data collection in federal population surveys should address the ability to account for this heterogeneity in survey design.