Racial and Ethnic Disparities in SSDI Entry and Health

This figure is a line graph titled, Yearly Disability Insurance Entry Rate.  The y-axis is labeled, number of entrants per million individuals. It ranges from 0 to 7500, increasing in increments of 1500. The x-axis represents time in years. It ranges from 1991 to 2015.  There are 5 lines on the graph: Non-Hispanic Native American, Non-Hispanic Black, Non-Hispanic White, Hispanic, and Non-Hispanic Asian. The Non-Hispanic Native American and Non-Hispanic Black lines move in a similar pattern. They start around 6500 in 1991, dip throughout the 90s to about 4500 to 5000 before bouncing back to approximately 7500 in 2009, and then dropping again to about 5000 in 2015. The non-Hispanic white line starts at around 4000 in 1991 before dropping slightly in the late 90s. It then rises throughout the 2000s, reaching a peak of close to 5000 in 2009 before dropping again to around 3500 in 2015. The Hispanic line follows a similar pattern but at a lower level, ranging from approximately 750 to 1000 less individuals per year than the non-Hispanic white line. The Non-Hispanic Asian line remains relatively stable, hovering around 1400 to 1700 throughout the study period, except for a small increase in 2009. The figure note reads, Estimates use Medicare entrants aged 22-62 in the years 1993-2017, corresponding to Disability Insurance entrants in the years 1991-2015. Estimates adjusted for potential population undercounting by race/ethnicity. The source line reads, Source: Researchers' calculations using data from Medicare and Census.

In a new study of Racial and Ethnic Disparities in SSDI Entry and Health (NBER RDRC Center Paper NB23-04)Colleen CareyNolan H. Miller, and David Molitor document significant racial and ethnic differences in the use of Social Security Disability Insurance (SSDI). Non-Hispanic Blacks and Native Americans enter the SSDI program at the highest rates relative to their share of the population while non-Hispanic Asians enter at the lowest rates. Average health status, measured by medical expenditure and mortality, is worst among SSDI entrants who are non-Hispanic Blacks and Native Americans and best among Asians and Hispanics. Economic conditions affect SSDI claiming: every 1 percentage point increase in the local unemployment rate leads to roughly a 4.5 percent rise in entry for non-Hispanic Whites, Blacks, and Asians. Entry among Hispanics and Native Americans increases about half as much as for the other groups.  

Non-Hispanic Blacks are 1.5 to 2 times more likely to receive SSDI benefits than Whites and 4 to 5 times more likely than Asians. They also are the group that uses the most medical care.  

Although the Social Security Administration does not include race and ethnicity in its public-use SSDI databases, race identifiers can be obtained from Medicare records, as SSDI recipients qualify for Medicare benefits after a 24-month waiting period. After adjusting for potential undercounting by race/ethnicity, the researchers find that non-Hispanic Blacks and Native Americans are 1.5 to 2 times more likely to receive benefits than Whites and 4 to 5 times more likely than Asians. Non-Hispanic Blacks also spend about 40 percent more on medical care than non-Hispanic Whites and Asians.

The SSDI program uses a five-step process to determine whether applicants have disabilities that limit their ability to work. To qualify, they must be unemployed and diagnosed with a significant work-limiting condition likely to last for at least a year. The program also considers whether they can do other work, which takes other factors into account, such as their level of education. Those found unable to perform sustained work receive cash benefits and health insurance through Medicare.

These eligibility rules are relaxed for applicants at age 50 and again at age 55 and over. Participation jumps for all races when these milestones are reached, particularly at age 50 when it surges by 79 percent for non-Hispanic Native Americans, 78 percent for Hispanics, and 73 percent for non-Hispanic Blacks. Hispanic White participation surges by 64 percent and Asian participation surges by 51 percent.

Because of limitations in the data, conclusions should be drawn carefully, the researchers caution. For example, non-Hispanic Blacks could be more likely to enter SSDI because, on average, they have more medical conditions that limit their ability to work. It is also possible, however, they do not gain access to the program until their medical conditions have progressed further and become more severe than for individuals in other groups. The researchers only have data on the health outcomes of SSDI recipients; they do not have information on those who are not admitted. 

– Laurent Belsie

Research reported in this paper was supported by the National Institute on Aging of the National Institutes of Health (NIH) under award number P01AG005842 and was performed pursuant to grant RDR18000003 from the SSA funded as part of the Retirement and Disability Research Consortium. The opinions and conclusions expressed are solely those of the authors and do not represent the opinions or policies of the NBER, NIH, SSA, or any agency of the federal government.