Disability and Housing Insecurity Among Older Adults: Mediating Roles of Neighborhood Environments and the Moderating Role of Race

Introduction and Background:
Older adults with disabilities face structural barriers, including limited income, inaccessible housing, and unequal neighborhood environments, which undermine their ability to age in place. While challenges differ by disability type, existing research often reduces disability to a binary measure or examines only one type. Moreover, although physical and perceived neighborhood environments may each mediate the relationship between disability and housing insecurity through distinct mechanisms, few studies examine both simultaneously. These pathways may also differ by race due to historical and structural inequalities in housing and neighborhood access. This study investigates how different types of disability are associated with housing insecurity among older adults, testing the mediating roles of physical and perceived neighborhood environments and the moderating role of race.

Methods:
We use data from the 2023 American Housing Survey (N=12,597), a nationally representative dataset of U.S. housing characteristics. The sample is restricted to adults aged 65 and older. Disability is classified into three types: mental, physical, and both. Housing insecurity is measured through a composite index that includes eviction concerns, lack of alternative housing, recent homelessness, perceived safety, mold exposure, and frequent moves. Physical neighborhood conditions are assessed through observed environmental deterioration within 300 feet of the home, while perceived neighborhood environment is based on residents' ratings of local schools, transit, safety, and disaster risk. Structural equation modeling (SEM) is used to estimate mediation effects, and multi-group analysis is conducted to examine racial differences.

Results:
SEM results indicate that older adults with mental, physical, or both disabilities are associated with poorer neighborhoods physical conditions compared to those without disabilities (β=0.042, 0.060, 0.079; all p<.001). Those with physical (β=-0.038, p<.001) and both disabilities (β=-0.080, p<.001) are also associated with worse perceptions of their neighborhood environments. A direct association between disability and housing insecurity is found only among older adults with both disabilities (β=0.027, p<.01). Physical neighborhood conditions significantly mediate the relationship between disability and housing insecurity across all disability types (mental: p<.01; physical: p<.001; both: p<.001), while perceived neighborhood environment does not have a significant mediating effect. Multi-group analysis shows that the association between both disabilities and poorer physical conditions holds true for White (p<.001), Black (p<.01), and Hispanic (p<.001) older adults. While perceived neighborhood disadvantage is significant for all these racial groups, the direct effect of disability on housing insecurity is found only among White older adults (p<.01).

Conclusions and Implications:
This study advances disability and housing research by disaggregating disability types and jointly modeling physical and perceived neighborhood environments. Findings show that physical neighborhood conditions are a key pathway linking disability to housing insecurity in later life, especially for those living with co-occurring mental and physical disabilities. These associations are consistent across racial groups, although direct effects on housing insecurity are observed only among White older adults, suggesting possible differences in unmeasured protective or risk factors. Policy efforts should prioritize structural neighborhood improvements and tailored, disability specific strategies to promote housing stability and support aging in place.