Living Alone and Routine Checkup Disparities Among Older Adults With Disabilities in the United States: The Mediating Role of Social Determinants of Health

Objective To examine the association between living alone and receipt of routine checkups among older adults with disabilities in the United States and explore the role of social determinants of health (SDOH) in explaining this relationship. Method Using 2023 Behavioral Risk Factor Surveillance System data, we analyzed adults aged 60+ with disabilities ( n = 56,619). Adjusted logistic regressions examined the association between living arrangement and annual routine checkups. Indirect effects of nine SDOH were tested. Results Older adults with disabilities living alone had significantly lower odds of an annual routine checkup compared to those cohabitating. The relationship between living alone and routine checkups showed significant indirect pathways through housing instability, transportation barriers, stress, and reduced social support. Conclusions These findings underscore living alone as an important marker of routine checkup disparities and suggest that efforts to reduce disparities must consider the material and psychosocial conditions that structure how individuals engage with healthcare.