Approximately one in four adults in the United States (U.S.) live with a disability that affects major life activities, and prevalence increases with age.1 Disability, an umbrella term encompassing impairment, participation restriction, and activity limitation within personal and environmental factors,2 is associated with higher poverty rates and disparities in income, education, and employment; particularly among racial/ethnic minorities.1,3 Before the COVID-19 pandemic, adults with disabilities already faced community mobility, housing, and transportation barriers.3, 4, 5 Crises such as the COVID-19 pandemic often amplify disparities.1 Consequently, people with disabilities may have encountered heightened challenges during the pandemic, as evident in reports highlighting the failure to provide access to food deliveries, internet services, COVID-19 testing, and other resources.6 Indeed, research conducted during the early months of the COVID-19 pandemic confirmed that older adults with physical disabilities were more likely, compared to those without any disabilities, to report perceived food insecurity and difficulty paying regular and medical bills.7 Others have similarly reported that people with disabilities were more likely, compared to those without disabilities, to experience financial hardship and forgo basic household necessities to pay bills during the COVID-19 pandemic.8,9

Older age and multimorbidity are closely associated with disability and are leading indicators of increased susceptibility to SARS-CoV-2 infection and poorer outcomes if infected.10 It is not necessarily the disability that heightens the health risk from infection with SARS-CoV-2.11 However, reports show an increased risk of death and adverse outcomes among individuals with disabilities,6,12 likely reflecting multimorbidity.13 Data show that severe COVID-19 disease is associated with lower socioeconomic status (SES), residing in densely populated communities, homelessness, food insecurity, and belonging to racial/ethnic minority groups.10 People with disabilities commonly fit into those high-risk demographics,1 making them among the most vulnerable during the COVID-19 pandemic. Vaccination and testing are crucial strategies for containing the spread of the virus. However, individuals with disabilities face barriers to COVID-19 vaccination,14,15 and challenges accessing testing sites.16 A qualitative study conducted among adults living with disabilities in Canada highlighted routine barriers to accessing COVID-19 vaccines, including difficulties accessing vaccine information, appointment booking, and physical access to vaccination sites.17

Individuals with disabilities also face barriers to healthcare access,1 which is particularly concerning during the COVID-19 pandemic as this population already faces a high burden of multimorbidity.10,13 Studies have highlighted difficulties accessing healthcare services for this population.4 Others have also reported an increased likelihood of COVID-19-related delays in and forgone medical care during the COVID-19 pandemic in adults with disabilities compared to those without.18

This study aimed to investigate the relationships between disability and COVID-19-related challenges, testing, vaccination, and infection with SARS-CoV-2. A secondary aim investigated if disability and related challenges could predict loss of healthcare coverage and postponement and avoidance of medical care during the pandemic.