Independent Living Difficulty

Why do we measure Independent Living Difficulty as a type of disability?

In the U.S. Census Bureau’s American Community Survey, adult respondents are asked to report if they have difficulty with hearing, vision, cognition, ambulation, self-care, and independent living. One-third of older adults and almost 13% of all U.S. adults report having one of these six types of functional disability.¹ Responses to difficulty with “independent living”, or difficulty doing errands alone, showed that almost 6% of U.S. adults living in community settings report difficulty with errands such as visiting a doctor’s office or shopping because of a physical, mental, or emotional condition in 2023.^2-3 Such conditions can fluctuate over time or be chronic, and may have been present at birth or related to a subsequent illness or injury.⁴ Similarly, there can be wide variation in the types of support needed by those who identify as having difficulty living independently.⁵

In selecting which of the six ACS disability measures to include on the Dashboard, the Dashboard team chose Independent Living Difficulty because of the many effective approaches to addressing this type of disability that neighborhoods and communities can consider for prioritization and adoption.

Adults with disabilities disproportionately face health-related challenges to their wellbeing, whether in accessing preventative services and care for chronic conditions or pursuing certain educational and employment opportunities.^6-10 Compared to the general population, people with disabilities experience significant health disparities for chronic diseases, such as obesity, heart disease, diabetes, and have lower life expectancy.^9-13 In 2023, the National Institutes of Health designated people with disabilities as a population with health disparities, signaling an investment of resources into research to improve health outcomes and equity for people with disabilities.¹³ A disability inclusion framework can help foster greater engagement and participation in the community on the part of persons with disabilities.^14-17

How do we measure Independent Living Difficulty as a type of disability?

We define this metric as the percentage of adults who report difficulty doing errands alone because of a physical, mental, or emotional condition.

The rate of independent living difficulty may differ depending on whether a survey includes individuals living in institutional settings such nursing homes, adult care facilities, prisons, or supported living care settings.¹⁷ The version we use in the Dashboard does not include persons who live in institutional settings, focusing instead on the population living in the general community.

Strengths and Limitations

Calculation

Independent Living Difficulty is calculated by the following formula:

This metric was calculated by aggregating estimates from smaller geographies to the congressional district level. For more information on the calculation, please refer to the. For more information on the calculation, please refer to the Congressional District Health Dashboard Technical Document.

Data Source

Estimates for this metric are from American Community Survey data using the S1810 table(s). Multi-year data are available for this metric.

Years of Collection

Calculated by the Dashboard Team from 2024, 5 year estimate.

References

1. U.S. Census Bureau. (n.d.) Why We Ask Questions About... Disability https://www.census.gov/acs/www/about/why-we-ask-each-question/disability/

2. U.S. Census Bureau. (2021, November 21) How Disability Data are Collected from The American Community Survey https://www.census.gov/topics/health/disability/guidance/data-collection-acs.html

3. U.S. Census Bureau. (2023) 2018-2022 American Community Survey 5-year Estimates. [Obtained via API]. Retrieved from https://api.census.gov/data/2022/acs/acs5/subject/groups/S1810.html

4. Center for Disease Control and Prevention. (2024, April, 3) Disability and Health Overview https://www.cdc.gov/disability-and-health/about/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/disabilityandhealth/disability.html

5. Center for Disease Control and Prevention. (2020, September 16) Disability and Health Information for People with Disabilities https://www.cdc.gov/disability-and-health/about/information-for-people-with-disabilities.html?CDC_AAref_Val=https://www.cdc.gov/ncbddd/disabilityandhealth/people.html

6. Okoro CA, Hollis ND, Cyrus AC, Griffin-Blake S. Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:882–887. DOI: http://dx.doi.org/10.15585/mmwr.mm6732a3

7. Armour BS, Thierry JM, Wolf LA. State-level differences in breast and cervical cancer screening by disability status: United States, 2008. Womens Health Issues. 2009 Nov-Dec;19(6):406-14. doi: 10.1016/j.whi.2009.08.006. PMID: 19879454.

8. Loeb M, Madans J, Weeks J, Miller K, Dahlhamer J, Golden C. Disability and participation: assessing employment and education outcomes in the National Health Interview Survey (2010). In: Barnartt SN, Altman BM, eds. Research in social science and disability, vol. 7: disability and intersecting statuses. Bingley, UK: Emerald Group Publishing Limited, 2013:171–88.

9. Krahn GL, Walker DK, Correa-De-Araujo R. Persons with disabilities as an unrecognized health disparity population. Am J Public Health. 2015 Apr;105 Suppl 2(Suppl 2):S198-206. doi: 10.2105/AJPH.2014.302182. Epub 2015 Feb 17. PMID: 25689212; PMCID: PMC4355692.

10. Pharr JR, Bungum T. Health disparities experienced by people with disabilities in the United States: a Behavioral Risk Factor Surveillance System study. Glob J Health Sci 2012;4:99–108.

11. Center for Disease Control and Prevention. (2024, May 15) Disability Impacts All of Us. https://www.cdc.gov/disability-and-health/articles-documents/disability-impacts-all-of-us-infographic.html?CDC_AAref_Val=https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.htmlhttps://www.cdc.gov/disability-and-health/articles-documents/disability-impacts-all-of-us-infographic.html?CDC_AAref_Val=https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html

12. Altman B, Bernstein A. Disability and health in the United States, 2001–2005. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2008. https://www.cdc.gov/nchs/data/misc/disability2001-2005.pdf

13. National Institutes of Health. (2023, September 26) News Release: NIH designates people with disabilities as a population with health disparities, U.S. Department of Health and Human Services, National Institutes of Health. Retrieved July 16, 2024, from https://www.nih.gov/news-events/news-releases/nih-designates-people-disabilities-population-health-disparities

14. Cegarra, B., Cattaneo, G., Ribes, A., Solana-Sánchez, J., & Saurí, J. (2023). Independent living, emotional well-being, and quality of life in people with disabilities: the mediator role of self-determination and satisfaction with participation. Frontiers in psychology, 14, 1279014. https://doi.org/10.3389/fpsyg.2023.1279014

15. Center for Disease Control and Prevention. (2020, September, 15). Disability and Health Inclusion Strategies. https://www.cdc.gov/disability-inclusion/strategies/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/disabilityandhealth/disability-strategies.html

16. Center for Disease Control and Prevention. (2020, September 16) Disability Inclusion. https://www.cdc.gov/disability-inclusion/about/index.html

17. Brault, M., Stern, S., & Raglin, D. (2007, January 3) Evaluation Report Covering Disability. 2006 American Community Survey Content Test Report P.4 U.S. Census Bureau. https://www.census.gov/library/working-papers/2007/acs/2007_Brault_01.html

Last Updated: April 28, 2026