Air pollution exposure among people with limitations in activities of daily living in the United States

Structural barriers including limited healthcare access and disability-related health conditions make disabled people differentially susceptible to air pollution-related adverse health outcomes compared to nondisabled people. We used 2020 census-tract level counts of individuals with limitations in activities of daily living (ADLs) to identify a subset of disabled people. We described geographic areas where this population was highly exposed to air pollution in the contiguous U.S., indicsating health risk. We assessed census tract-level exposure to PM_2.5, O₃, NO₂ (2016-2020), and wildfire PM_2.5 (2016-2023). We mapped high ADL limitation prevalence and high air pollution exposure census tracts. Because environmental injustice means race and poverty strongly predict air pollution exposure, we also assessed exposure among people with ADL limitations by these demographic factors to identify doubly vulnerable subpopulations. High ADL limitation prevalence and PM_2.5/NO₂ exposure co-occurred in urban areas, California's Central Valley, Eastern Washington, and parts of the Southeast. Among people with ADL limitations, Asian and Hispanic individuals and those experiencing poverty were more exposed to PM_2.5, O₃, and NO₂. Disability is not fully captured by ADL limitations; future studies should explore other definitions of disability. Future studies should evaluate interventions to reduce air pollution-related morbidity and mortality, especially in regions and subpopulations identified here, where disabled people face high exposure and multiple vulnerabilities.