Do U.S. states' socioeconomic and policy contexts shape adult disability?

• Differences in the prevalence of adult disability across US states are substantial.
• Adults in some states reach levels of disability 1-2 decades before other states.
• State contexts help explain the differences, net of individual and local factors.
• State contexts were most important for older adults, similarly important by gender.
• States' economies, income inequality, EITC, and cigarette taxes are important.

Growing disparities in adult mortality across U.S. states point to the importance of assessing disparities in other domains of health. Here, we estimate state-level differences in disability, and draw on the WHO socio-ecological framework to assess the role of ecological factors in explaining these differences. Our study is based on data from 5.5 million adults aged 25–94 years in the 2010–2014 waves of the American Community Survey. Disability is defined as difficulty with mobility, independent living, self-care, vision, hearing, or cognition. We first provide estimates of age-standardized and age-specific disability prevalence by state. We then estimate multilevel models to assess how states' socioeconomic and policy contexts shape the probability of having a disability. Age-standardized disability prevalence differs markedly by state, from 12.9% in North Dakota and Minnesota to 23.5% in West Virginia. Disability was lower in states with stronger economic output, more income equality, longer histories of tax credits for low-income workers, and higher cigarette taxes (for middle-age women), net of individuals' socio-demographic characteristics. States' socioeconomic and policy contexts appear particularly important for older adults. Findings underscore the importance of socio-ecological influences on disability.