Comparing survey reporting of standard and alternative measures of disability status and disability identity among adults ages 18 to 64.

BACKGROUND: Federal disability data collection standards require national population health surveys to assess limitations across six functional domains. These questions underrepresent people with certain disabilities, posing challenges for estimating disparities and motivating efforts to develop alternative measures aligned with federal antidiscrimination law. OBJECTIVE: To examine who is captured by alternative measurement approaches but is missed by standard measures, including among adults with self-identified disabilities. METHODS: Using December 2024 data from a nationally representative survey of 18-64-year-old adults, we compare responses to the six-item American Community Survey (ACS-6) functional limitation questions; an alternative Comprehensive Disability Status (CDS) question about presence of a long-term health condition, impairment, or disability and related activity limitations; and disability identity. We examine who the CDS identifies beyond those captured by the ACS-6 and how responses among self-identified disabled adults are associated with sociodemographic characteristics using linear probability models. RESULTS: Thirteen percent of respondents self-identified as disabled, 20% reported a functional limitation based on the ACS-6, and 27% reported a long-term condition, impairment, or disability based on the CDS, half of whom had activity limitations. Among adults self-identifying as disabled, 76% reported a functional limitation from the standard ACS-6 question set and 90% responded affirmatively to the CDS. Compared with adults reporting one or more functional limitations from the ACS-6, those captured by the CDS but not the ACS-6 reported higher levels of employment, income, and educational attainment, with varying differences by disability identity. CONCLUSION: Understanding intersections between standard and alternative survey questions on disability status and disability identity can inform efforts to develop inclusive measurement approaches.