Trends in dental care utilization and cost-related access barriers among working-age adults with and without disabilities, 2019-2023.

BACKGROUND: Adults with disabilities have long faced lower dental utilization and greater cost-related barriers than adults without disabilities, yet the impact of the COVID-19 pandemic on these disparities among working-age adults has not been examined at the population level. OBJECTIVE: To examine whether disparities in dental care use and cost-related access barriers between working-age adults with and without disabilities changed during the COVID-19 pandemic. METHODS: We analyzed nationally representative data from the 2019, 2020, 2022, and 2023 National Health Interview Surveys (adults aged 18-64). Disability was defined using the Washington Group Short Set. Outcomes were three past-12-month measures: dental visit (exam or cleaning) and cost-related delayed and forgone dental care. Stratified weighted logistic regressions estimated average marginal effects relative to 2019, adjusting for demographic and socioeconomic factors. RESULTS: Among adults without disabilities, dental visits remained below 2019 levels in 2020, 2022, and 2023. Among adults with disabilities, dental visits declined in 2020 (-5.3 percentage points [pp]; 95% CI, -9.6 to -1.0) and 2022 (-4.8 pp; 95% CI, -9.2 to -0.5) but recovered by 2023; delayed care fell in 2022 (-4.6 pp; 95% CI, -8.4 to -0.9). Cost-related delayed and forgone care remained substantially higher among adults with disabilities throughout. CONCLUSION: COVID-19 was associated with larger short-term reductions in dental utilization among working-age adults with disabilities, but their utilization recovered by 2023 while disparities in cost-related unmet dental care persisted. Stabilizing dental care coverage and provider capacity, while protecting access during future public health emergencies, may help reduce these gaps.