Factors associated with unmet needs for disability supports, 2022

Overview of the study

This paper uses
the 2022 Canadian Survey on Disability (CSD) to explore the unmet needs of
persons with disabilities for different types of disability supports. The
following types of support are examined: health care services, prescription medication, assistive aids or
devices and help with everyday activities. It takes a look at how each area of
unmet need varies by different characteristics, such as, age, gender, income,
or severity of disability.

• 
  The rate of unmet needs among persons with
  disabilities varied by type of support: 13.5% for prescription medication,
  22.7% for assistive aids or devices, 32.7% for help with everyday activities
  and 45.7% for health care services
• 
  Severity of disability and encountering barriers
  to accessibility were significant predictors of having unmet needs in each area
  of support
• 
  Other common predictors across areas of support
  included age and gender
• 
  Individuals with fluctuating, recurrent or
  progressive limitations had higher odds of experiencing unmet needs for health
  care services and for help with everyday activities
• 
  Negative self-rated health status was associated
  with unmet needs for health care services, medication and help with everyday
  activities
• 
  Persons with disabilities who considered
  themselves housebound had higher odds of having unmet needs for health care
  services and help with everyday activities
• 
  Loneliness was associated with increased odds of
  having unmet needs for health care services, medication and help with everyday
  activities

Introduction

Access to different programs, services and
supports can play a key role in the lives of the nearly 8 million persons with
disabilities in Canada. Persons with disabilities often require more services
and supports than persons without disabilities, but many also report higher
rates of unmet needs for various types of support (Casey, 2015; McColl et al., 2010).
Previous studies have consistently shown that unmet needs for different types
of support are associated with poorer scores on various quality of life measures
(Chong et al., 2021; Ju at al., 2017). Some of the main areas where persons
with disabilities require services and support include access to health care
services, medication, assistive aids or devices and help with everyday
activities.

Research has shown that many Canadians have
unmet needs for health care services, including mental health care and home
care, due to barriers related to availability, accessibility or acceptability
of the services required (Gilmour, 2018; Sanmartin et al., 2002). Persons with
disabilities are more likely to report unmet health care needs, compared with
their counterparts without disabilities and characteristics such as, gender,
age, and income, as well as having multiple conditions and higher assistance
needs with daily activities, are associated with these unmet needs (McColl et al., 2010; Reichard et al., 2017). Perceived severity of disability is also an
important factor, where research indicates that those who consider their
disability as more serious expressed lower satisfaction with their
health-related support than those who considered their disability as relatively
minor (Blažeka Kokorić et al., 2012).

Use of prescription medication is more
common among persons with disabilities or chronic conditions (Peklar et al.,
2017; Rotermann et al., 2014). Cost-related issues have been linked to not
refilling or delaying refilling a prescription, as well as skipping doses or
taking less medication to ensure it lasted longer (Heidari et al., 2019). In
2021, almost 10% of Canadians who took prescribed medication reported
cost-related non-adherence^Note  ,
with a higher proportion of those without insurance coverage reporting this
situation (Cortes & Smith, 2022). Non-adherence behaviours among persons
with disabilities have been linked to poorer health outcomes and to negative
impacts on quality of life (Jensen & Li, 2012; Tamblyn et al., 2001). Medication
adherence can be impacted by factors such as age, household income, employment
status and having help with medication (Gupta et al., 2018; Huang et al.,
2019).

Assistive aids or devices can help persons
with disabilities independently perform tasks and participate in daily
activities and it is estimated that by 2050 the need for them will reach 3.5
billion people globally (WHO, 2022). However, many individuals report unmet
needs for the aids and devices they require (WHO, 2018). Research has shown
that the use of assistive devices leads to better rated functional performance,
quality of life scores, and wellbeing (Ali et al., 2020; Hammel et al., 2002).
Among persons with disabilities, a variety of barriers leading to unmet needs
for aids or devices have been highlighted, including affordability, lack of
support or information, or lack of availability (Mishra et al., 2024; WHO &
UNICEF, 2022).

Formal and informal networks can play an
important role in the daily lives of persons with disabilities in terms of
providing help with everyday activities. In 2018, 25% of Canadians reported
providing help or care for family or friends with a long-term condition,
disability or challenges associated with aging (Arriagada, 2020). Informal
support networks, such as support from family and friends, or more formal
support from service providers, have been identified as facilitators for a
variety of daily activities for persons with disabilities (Hammel et al, 2015; Heeb
et al., 2022). This care and social support can impact various aspects of
quality of life, as increased social support has been associated with higher
perceived mental health status (Krokavcova et al., 2008) and some research
points to a connection to physical functioning (Miller & Chan, 2008) as
well as improved health outcomes (Chong et al., 2021).

A variety of individual and environmental
factors can contribute to the requirements for and ability to access different
services and supports. Gaining a better understanding of the profile of those
with unmet needs and the factors associated with these unmet needs may inform
service planning and interventions to ultimately allow for greater
participation for persons with disabilities.

Given that health care services, prescription medication, assistive aids or devices and help with everyday activities are a diverse set of supports, a closer look at the dynamics surrounding each
type of support is an important next step to better understand the impact of
unmet needs on persons with disabilities. The main objective of the current
study is to examine each of the four support areas separately. It examines
prevalence rates of unmet need in each area and then investigates the
association of certain demographic, socioeconomic and disability or
accessibility-related characteristics on each type of unmet need.

Data and Methods

Data source

The Canadian Survey on Disability

This study used data from the 2022 Canadian
Survey on Disability (CSD), a national survey of Canadians aged 15 and over
whose everyday activities are limited because of a long-term condition or
health-related problem. The CSD provides comprehensive data on persons with
disabilities for each province and territory. The survey also collects
essential information on disability types and severity, supports for persons
with disabilities, their employment profiles, income, education and other
disability-specific information.

The survey population for the 2022 CSD was
comprised of Canadians aged 15 years and over as of the date of the 2021 Census
of the Population (May 2021) who were living in private dwellings. It excludes
those living in institutions, on Canadian Armed Forces bases, on First Nations
reserves, and those living in collective dwellings.^Note  As the
institutionalized population is excluded, the data, particularly for the older
age groups, should be interpreted accordingly.

The CSD uses Disability Screening Questions
(DSQ) which are based on the social model of disability (Grondin, 2016). They
require that a limitation in daily activities be reported for the
identification of a disability—the presence of a difficulty alone is not
sufficient. To identify persons with a disability, the DSQ first measure the
degree to which difficulties are experienced across various domains of
functioning and then ask how often daily activities are limited by these
difficulties. Only persons who report a limitation in their day-to-day
activities are identified as having a disability. The CSD definition of
disability includes anyone who reported being “sometimes”, “often” or “always”
limited in their daily activities due to a long-term condition or health
problem, as well as anyone who reported being “rarely” limited if they were
also unable to do certain tasks or could only do them with a lot of difficulty.

Measures

Health care services

To determine
the level of needs met for health care services, respondents were asked a
series of questions about whether they received, needed more of, or needed but
did not receive a variety of different types of therapies or services because
of their condition. This included the following therapies or services:
physiotherapy, massage therapy or chiropractic treatments; speech therapy;
occupational therapy; counselling services from a psychologist, psychiatrist,
psychotherapist or social worker; support group services, drop-in center services or telephone
information or support lines; life
sustaining therapies or specialized medical care; addiction services; life
skills program or services; naturopathic, homeopathic or osteopathic treatments;
acupuncture; nutrition or dietary services; specialized vision care from an
ophthalmologist optometrist or optician; or other therapy or service. For the
purposes of this report, those who indicated that they needed a therapy or
service and did not receive it or those who indicated they needed to receive
more of a required therapy or service were defined as having an “unmet need”.

Prescription medication

To assess unmet
needs for prescription medications, respondents were asked if they were ever
unable to purchase required medication or took their medication less often
because of cost, within the last 12 months. For the purposes of this report,
those who said “yes” to one or both of these questions were defined as having an
“unmet need”. It is important to note that this need area asked respondents
specifically about cost as the reason for each behaviour within the question,
whereas the other need areas examined in this report did not specify the reason
within the questions but instead had follow up questions on reasons, with cost
as one of many reasons.

Assistive aids or devices

An aid or assistive
device is any device or tool designed or adapted to help a person perform a
particular task or activity. The CSD asked a number of questions regarding
needs for various personal aids, devices or technologies (e.g., canes, recording
or note taking equipment, large print materials, specialized software, or
architectural features in the home such as widened doorways and ramps).^Note  The
questions were asked for specific disability types, with a module for seeing
aids, hearing aids, physical aids (includes mobility, dexterity, flexibility)
and cognitive aids (includes developmental and learning), as well as one module
that was asked of all disability types. In each module, respondents were asked
if there were any aids that they needed and did not have, and subsequently to
identify the type of aid that they needed but did not have. For the purposes of
this report, those who indicated that there was at least one type of aid or
device that they needed but did not have were defined as having an “unmet
need”.

Help with everyday activities

To measure needs for help with activities
of daily living, respondents were asked if, because of their condition, they
received help, required help but did not receive it or needed more help with
different types of everyday activities. The following activities were covered:
preparing meals, everyday housework, heavy household chores, getting to
appointments or running errands, looking after personal finances, personal
care, basic medical care at home, moving around inside their residence or other
type of help. This includes help received from family, friends, neighbours and
organizations, whether paid or unpaid. For the purposes of this report, those who indicated that they
needed a type of help and did not receive it or those who indicated they needed
to receive more of a type of help were defined as having an “unmet need”.

Covariates

Demographics: Age was categorized into four groups:
15 to 24 years, 25 to 44 years, 45 to 64 years and 65 years and over. For
gender, a two-category gender variable was used to protect the confidentiality
of non-binary persons, given the relatively small size of this population in
Canada. More specifically, non-binary persons have been redistributed into the
“men” and “women” categories, denoted as “men+” and “women+”.^Note  Using
questions on sex at birth, gender identity and sexual orientation, the 2SLGBTQ+
variable includes those who reported being lesbian, gay, bisexual, pansexual or
another sexual orientation that is not heterosexual (LGB+), as well as
non-binary persons and transgender women and men. ^Note 

Household living arrangement was classified
as follows: no spouse, no children^Note  ;
with spouse, no children^Note  ;
two parent family^Note  ;
one parent family.

Population centres are defined as having a Census
population of at least 1,000 persons and a population density of 400 persons or
more per square kilometre. All areas outside of population centres are
classified as rural areas.

“Racialized” refers to whether a
person is a visible minority as defined by the Employment Equity Act as
“persons, other than Aboriginal peoples, who are non-Caucasian in race or
non-white in colour”. The racialized population consists mainly of the
following groups: South Asian, Chinese, Black, Filipino, Arab, Latin American,
Southeast Asian, West Asian, Korean and Japanese. The non-racialized category
includes those who identified as White only and excludes Indigenous people. For
the purposes of this report, immigrant status was defined as non-immigrant
(born in Canada) or immigrant (which included non-permanent residents). Indigenous
group was categorized as Indigenous (First Nations, Métis, and Inuit) or
non-Indigenous; disaggregation for First Nations people, Métis and Inuit was
not possible due to small sample sizes.

Socioeconomic status: Labour force status categories were employed, unemployed, or not in
the labour force.^Note 
For the purposes of this paper, educational attainment was grouped in the
following way: high school diploma or less; trade certificate, college diploma
or university credentials below the bachelor’s level; university certificate,
diploma or degree at bachelor level or above.^Note 
Income was represented by quintiles which were based on after-tax economic
family income adjusted by family size.^Note 

Health and wellbeing characteristics: Respondents were asked to rate their
general health by responding to the following question: “In general, would you
say your health is: excellent, very good, good, fair, or poor?”. For the
purposes of this paper, this was coded as a binary variable where those who
reported “excellent” or “very good” or “good” were classified as having
positive self-rated health and those who reported “fair” or “poor” were
classified as having negative self-rated health, similar to previous Statistics
Canada studies on unmet needs (Chen at al., 2002; Gilmour, 2018). The
three-item loneliness scale measures an individual’s loneliness by asking
respondents to answer on a scale of “hardly ever”, “some of the time” or
“often” to how often they: 1) feel they lack companionship, 2) feel left out,
3) feel isolated from others. Higher scores indicate greater loneliness, and
for the purposes of this report, those with a score of 6 or more were coded as
“lonely”.

Disability
and accessibility characteristics: A global
severity score was developed for the CSD, which was calculated for each person
using: the number of disability types that a person has, the level of
difficulty experienced in performing certain tasks, and the frequency of
activity limitations. To simplify the concept of severity, four severity
classes were established: mild, moderate, severe and very severe.^Note 

Episodic status was used to examine the
dynamic nature of disability by categorizing individuals into a group who
experience continuous limitations and another group who experience either fluctuating,
recurrent or progressive limitations. This group may experience periods where
they don’t feel limited, may have periods where they can do more activities but
fewer activities during other periods, or their ability to do daily activities
is getting worse over time.

Based on the average number of barriers to
accessibility experienced by persons with disabilities, which was around 6, the
categories of “lower rate” and “higher rate” of barriers experienced were
established.^Note 
The lower rate of barriers category includes those who experienced 1 to 6
barriers, while the higher rate category includes those who experienced 7 or
more barriers. This includes barriers encountered within public spaces, in
communication, with Internet use and related to behaviours, misconceptions or
assumptions made about them from others.

Housebound status is defined as being
unable to leave your home environment due to your condition. Respondents were
asked if they considered themselves housebound on a scale of “No”, “Rarely”,
“Sometimes”, “Often” or “Always”. For this report, those who indicated
“Sometimes”, “Often” or “Always” were classified as “housebound”.

Analysis

Due to the subjective nature of some of the
variables involved, proxy cases (10.4%) were excluded from the analysis. Those
with missing data were also excluded from the analysis.^Note  Descriptive
statistics were used to estimate the prevalence of experiencing unmet needs for
each disability support among persons with disabilities aged 15 years and over.

Logistic regression
modeling was used to identify the key factors associated with higher or lower
odds of having unmet needs, while controlling for the effects of other
disability-related and sociodemographic covariates at the same time. Findings
from the logistic regression analyses are reported using odds ratios (ORs) and
their 95% confidence intervals (CIs). Interpreting odds ratio results should be done
with caution. The value of odds ratio estimates determines the direction of the
effect (i.e., whether a certain group has higher or lower odds of experiencing
unmet needs) but their magnitude may vary given a different set of covariates or a
different sample; they are accordingly challenging to interpret and should not be
compared with odds ratios from other analyses (Norton et al., 2018).

For this report, the significance level was
set at p < 0.05. All estimates were weighted to represent the Canadian
population with disabilities aged 15 years and over. The bootstrap technique
was used to estimate variance and 95% confidence intervals to account for the
complex survey design.

Results

Prevalence of unmet needs for health care services

In 2022, 45.7% of persons with disabilities
reported at least one unmet need for health care services. The most commonly
reported unmet needs were related to physiotherapy, massage therapy or
chiropractic treatments (28.7%), counselling services from a psychologist,
psychiatrist, psychotherapist or social worker (18.5%), followed by acupuncture
(6.2%) (Chart 1).

Chart 1 start

Data table for Chart 1

Data table for chart 1

Table summary
The information is grouped by Type of therapy or service (appearing as row headers), Percent and 95% confidence interval, calculated using lower and upper units of measure (appearing as column headers).

Type of therapy or service	Percent	95% confidence interval
		lower	upper
Notes: Includes those who indicated they need a service or therapy but do not receive it and those who did not receive enough of a therapy or service. Respondents could have reported unmet needs for more than one type of health care service. Estimates were calculated based on the total population of persons with disabilities. Source: Statistics Canada, Canadian Survey on Disability, 2022.
Physiotherapy, massage therapy or chiropractic treatments	28.7	27.6	29.8
Counselling services	18.5	17.7	19.4
Acupuncture	6.2	5.6	6.8
Naturopathic, homeopathic or osteopathic treatments	5.9	5.3	6.4
Nutrition or dietary services	5.7	5.2	6.3
Specialized vision care from an ophthalmologist, optometrist or optician	4.5	4.0	5.1
Support group services	4.2	3.7	4.7
Other therapy	2.9	2.4	3.3
Occupational therapy	2.4	2.1	2.8
Life sustaining therapies or specialized medical care	2.2	1.9	2.6
Life skills program or services	2.1	1.7	2.4
Addiction services	1.2	1.0	1.6
Speech therapy	0.6	0.4	0.8

Chart 1 end

In terms of
demographic characteristics, the proportion of persons who experienced unmet
needs for health care services differed by age, gender, geography, being a 2SLGBTQ+ a person, racialized identity and Indigenous group (Table 1.1). The proportion of
persons with disabilities with unmet health care service needs was higher among
those aged 25 to 44 years (56.6%) and lower among those aged 65 years and older
(32.4%), when compared with youth (aged 15 to 24 years) (48.4%). Women (51.1%)
were more likely than men (38.4%) to report an unmet need for health care
services.

Those residing in rural areas (39.0%) were
less likely to report unmet needs for health care services compared with those
living in population centres (47.1%). A higher proportion of persons in one
parent families (54.2%) had unmet needs for health care services, compared with
those with no spouse and no children (45.1%). Conversely, couples without
children (41.3%) were less likely to have unmet needs in this area than those
with no spouse and no children (45.1%).

2SLGBTQ+ persons with disabilities (60.0%)
were more likely than their non-2SLGBTQ+ counterparts (44.1%) to experience
unmet needs for health care services. Racialized persons with disabilities (51.8%)
were more likely to have unmet needs in this area, compared with their
non-racialized, non-Indigenous counterparts (44.2%). Indigenous persons with
disabilities (51.0%) were more likely than non-Indigenous persons with
disabilities (45.4%) to have unmet needs for health care services.

Unmet needs for health care services among
persons with disabilities varied by aspects of socioeconomic status. Those not
in the labour force (40.7%) were less likely than employed individuals (49.2%)
to have unmet needs in this area, while unemployed individuals (55.0%) were
more likely to have unmet needs. Compared with those with a high school diploma
or less (42.0%), individuals with a post-secondary education below the
bachelor’s level (46.4%) and those with a bachelor’s degree or higher (51.7%)
were more likely to report unmet needs for health care services. There were no
significant differences in the prevalence of unmet needs for health care services
by income quintile.

Unmet needs for health care services also
differed by perceived health status as those with negative self-rated health (55.2%)
were more likely to have such unmet needs, compared with those with positive
self-rated health (40.6%). Those who experienced loneliness (59.9%) were more
likely to report unmet needs for health care services than those who did not
report being lonely (37.2%).

As disability severity increased, so did
the proportion of persons with disabilities who experienced unmet needs for
health care services. For example, persons with very severe disabilities (60.7%)
were more likely to have unmet needs in this area, compared with those with
mild disabilities (33.5%). Those with fluctuating, recurrent or progressive
limitations (49.7%) were more likely to have unmet needs for health care services
than those with continuous limitations (38.2%).

Experiencing unmet needs for health care services
was more prevalent among those who encounter barriers to accessibility. The
proportion of persons with disabilities who had unmet needs was both higher
among those who experienced a lower rate of barriers (46.1%) and those who
experienced a higher rate of barriers (61.6%), as compared with those who
reported experiencing no barriers to accessibility (27.3%). Unmet needs for
health care services were more likely among housebound individuals (59.4%) than
their non-housebound counterparts (38.9%).

Key factors associated with the
likelihood of having unmet needs for health care services

When all characteristics were considered
simultaneously, many of the demographic and socioeconomic characteristics that were
significant in the descriptive section, continued to be associated with unmet
needs for health care services.^{Note Note Note}  Results of
the model indicate that higher odds of unmet needs for health care services
were associated with being aged 25 to 44, being a woman, being part of the
2SLGBTQ+ population and having a higher education (Table 2.1). In addition, lower
odds of experiencing unmet needs for health care services were associated with
living in rural areas, being over the age of 65 and not being part of the
labour force.

Many of these findings are in line with
previous research, where women have been shown to more likely to have unmet
needs (Casey, 2015; Lee at al., 2024; McColl et al., 2010) and prior analysis
shows that those in early adulthood were found to be more likely to have unmet
needs, while older individuals are less likely to have unmet needs (Casey 2015;
Gilmour, 2018; Sibley & Glazier, 2009). Research suggests that lesbian, gay
and bisexual people report lower rated health status and are more likely to
report mental health disorders (Rauh, 2023). Additionally, the gender diverse
population has been shown to report increased unmet health care needs (Mulcahy
et al., 2022).

There is variation in findings on unmet
health care needs and geography. Unmet health care
needs have been shown to be both lower (Sibley & Glazier, 2009) and higher
(Rahman, 2022) among rural residents, while in other cases, no differences were
found by place of residence (Grimm & Ispen, 2022; Urbanoski et al., 2008).

There are also mixed results in terms of the
association between education and unmet healthcare needs within the literature.
There is some evidence that higher education can be a protective factor
(Starkes et al., 2005), while other studies show higher educational attainment
may result in an increased likelihood of reporting unmet needs (Sibley &
Glazier, 2009), potentially due to increased awareness or expectation of care
or increased dissatisfaction with the services being provided.  

When controlling for other factors, well-being,
disability and accessibility-related characteristics continued to be
significant predictors of unmet needs for health care services. Those with
negative self-rated health were more likely to report unmet needs in this area
(OR=1.2; 95% CI: 1.0, 1.4), compared with those who had positive self-perceived
health, which is consistent with previous research (Lee et al., 2024). Persons
with disabilities who experienced loneliness (OR=1.5; 95% CI: 1.3, 1.7) were at
a higher risk of unmet needs for health care services, compared with their
counterparts who did not report being lonely. Social isolation has been tied to
future health system utilization and shown to impact health outcomes (Courtin
& Knapp, 2017; Mosen et al., 2021).

The odds for having unmet needs for health
care services increased with disability severity. For example, those with very
severe disabilities (OR=2.3; 95% CI: 1.9, 2.8) had over two times higher odds
of experiencing unmet needs in this area, compared with those with mild
disabilities. Challenges such as needing multiple sources of care, difficulties
with care coordination, being unsure of where to go for all care requirements
and increased time spent seeking care have all been identified by persons with
comorbid conditions within their health care access experiences (Van der Aa,
2017).

Those with limitations that were episodic
in nature had higher odds of having unmet health care services needs (OR=1.2; 95%
CI: 1.1, 1.4) than those with limitations that were continuous in nature. Changes
in the pattern or severity of limitations experienced by persons with
disabilities may lead to changes in the need for certain supports. For example,
studies have found increased care-seeking behaviour and health care use in
persons with multiple sclerosis as they often have co-morbid conditions and
changes in limitations over time (Jones et al., 2016; Roux et al., 2019).

Those who faced a high number of barriers
to accessibility had nearly three times higher odds (OR=2.9; 95% CI: 2.4, 3.4) of
unmet needs for health care services when compared with those who experienced
no barriers to accessibility. Persons with disabilities have highlighted a
variety of barriers encountered in the health care setting, including issues
with cost, transportation, the physical environment of facilities,
communication with providers or misconceptions made about them by providers (Drainoni
et al., 2006; Maart & Jelsma, 2014; Rahman et al., 2022).

Housebound individuals with disabilities
were at an increased risk of experiencing unmet needs for health care services
(OR=1.3; 95% CI: 1.1, 1.5), compared with their counterparts who were not
housebound. In a previous study, housebound status was found to be a
significant factor in having unmet health care needs among older people (Herr
et al., 2013). Many of these individuals may require home-based services to
reduce barriers and receive care. Unmet home care needs have been connected to
negative self-rated health and increased number of chronic conditions, with the
most commonly identified barrier being availability (Gilmour, 2018).

Prevalence of unmet needs for prescription
medication

In 2022, 13.5% of persons with disabilities
reported that they were unable to purchase medication or took medication less
often due to cost. Among those who used prescription medications, 44.2%
reported not being reimbursed for some of their expenses, with over 4 in 10 (41.3%)
of these individuals indicating their out-of-pocket expenses were over $500 in
the past 12 months (Chart 2).

Chart 2 start

Data table for Chart 2

Data table for chart 2

Table summary
The information is grouped by Amount of unreimbursed expenses (appearing as row headers), Percent and 95% confidence interval, calculated using lower and upper units of measure (appearing as column headers).

Amount of unreimbursed expenses	Percent	95% confidence interval
		lower	upper
Note: Includes those who indicated they have taken medication in the past 12 months and had expenses that were not reimbursed – not covered by insurance. Source: Statistics Canada, Canadian Survey on Disability, 2022.
Less than $500	53.5	51.7	55.3
$500 to $999	21.2	19.7	22.6
$1,000 to $1,999	11.0	9.9	12.1
$2,000 to $4,999	7.2	6.3	8.2
$5,000 or more	2.0	1.4	2.5
Don’t know	5.2	4.4	6.0

Chart 2 end

Compared with
youth (aged 15 to 24 years) (15.2%), a lower proportion of those aged 65 years
and older (7.4%) reported this type of unmet need (Table 1.1). Women (15.0%) were
more likely than men (11.4%) to have unmet needs for medication due to cost.

Residents of rural areas (10.7%) were less
likely to report unmet medication needs, compared with those living in
population centres (14.1%). Unmet needs for medication also varied by household
living arrangement as those with a spouse and no children (9.8%) and two-parent
families (11.6%) were less likely to have unmet needs in this area than those
with no spouse and no children (15.3%). Conversely, one-parent households (23.4%)
were more likely to have unmet needs for medication, compared with those with no
spouse and no children (15.3%).

Similar to unmet needs for health care services,
unmet needs for medication varied among the 2SLGBTQ+, racialized and Indigenous
populations. 2SLGBTQ+ persons with disabilities (20.8%) were more likely than
their non-2SLGBTQ+ counterparts (12.5%) to experience unmet needs for medication.
Racialized persons with disabilities (18.7%) were more likely to have unmet
needs in this area, compared with their non-racialized, non-Indigenous
counterparts (12.2%). Indigenous people with disabilities (18.8%) were more
likely than non-Indigenous people with disabilities (13.2%) to have unmet medication
needs.

In terms of labour force status, unemployed
persons with disabilities (23.6%) were more likely to have unmet medication
needs when compared with employed persons with disabilities (12.7%). A lower
proportion of those with a bachelor’s degree or higher (9.1%) reported unmet
needs in this area than those with a high school diploma or less (14.9%). Unmet
needs for medication were more prevalent in lower income groups, for example,
those in the lowest income quintile (19.6%) were almost three times more likely
to experience unmet needs in this area, compared with those in the highest
income quintile (6.6%). 

Persons with disabilities who reported
negative self-rated health (20.8%) were more likely than those with positive
self-rated health (9.6%) to have unmet needs for medication. The prevalence of
unmet needs for medication was also higher among individuals who experienced
loneliness (20.7%), compared with those who did not experience loneliness
(8.5%).

Unmet needs for medication varied by
disability severity, as 24.1% of those with very severe disabilities
experienced this type of unmet need, compared with 7.0% of those with mild
disabilities. Those with fluctuating, recurrent or progressive limitations (15.0%)
were more likely to have unmet needs for medication than those with continuous
limitations (10.8%).

Encountering barriers to accessibility was
associated with unmet needs for medication, as those who experienced a high
rate of barriers (21.4%) were more likely to report unmet needs in this area,
compared with those who experienced no barriers to accessibility (6.5%). Persons
with disabilities who reported being housebound (21.2%) were more likely to
experience unmet needs for medication than their non-housebound counterparts
(9.8%).

Key factors associated with the likelihood of having unmet
needs for prescription medication

Results of the
model indicate that unmet needs for prescription medication were associated with
being a woman, being a 2SLGBTQ+ person, belonging to a racialized group, and
being unemployed (Table 2.1). As anticipated, unmet needs for medication was
strongly associated with income, given this area of need was directly related
to cost. Those in the lowest income quintile faced over two and a half times
higher odds (OR=2.7; 95% CI: 1.9, 3.8) of experiencing unmet needs for
medication, when compared to those in the highest income quintile. A lower
likelihood of having unmet needs for medication was associated with being 65
years or older, not being in the labour force and having a bachelor’s degree or
higher. While differences in unmet needs for medication emerged by place of
residence, Indigenous group, household living arrangement, episodic disability
status and housebound status in the descriptive analysis, these differences did
not persist when all other factors were held constant.

Socioeconomic status has often been
associated with facing financial barriers to medication use. Factors such as
irregular employment, lower educational attainment and, most of all, lower
income levels, have all been linked to cost issues with prescription medication
(Gupta et al., 2018; Kapur & Basu, 2005; Rolnick et al., 2013).
Cost-related non-adherence to medication has also been found to differ by
gender, race or ethnicity and sexual orientation (Rebić et al., 2024).

Many of the demographic and socioeconomic
factors may be reflective of certain characteristics of the health care system
in Canada. Research into drug coverage in Canada has shown that it rises with
age, with the majority of those age 65 and older being covered by public
programs (Kapur & Basu, 2005), which could lead to a lower likelihood of
having unmet needs for medication. Findings for labour force status can reflect
that many working age Canadians are covered though employer provided plans,
while those not working have a lower likelihood of being covered by any type of
drug insurance plan (Yang & Gupta, 2024).

Consistent with previous research (Gupta et al., 2018; Law et al., 2018), those with poorer self-rated health were more
likely to report unmet needs for medication (OR=1.5; 95% CI: 1.2, 1.8),
compared with those who had positive self-perceived health. Loneliness was also
associated with unmet needs in this area as those who experienced loneliness
(OR=1.5; 95% CI: 1.2, 1.8) had higher odds of unmet needs, compared with their
counterparts who did not report being lonely. This could be connected to a
shortage of caregiving support due to social isolation, as the presence of
social support resources is linked to increased medication adherence (Scheurer
et al., 2012).

The odds of experiencing unmet needs for
medication increased with severity of disabilities. Compared with persons with
mild disabilities, those with moderate (OR=1.7; 95% CI: 1.3, 2.2), severe
(OR=1.9; 95% CI: 1.5, 2.4) or very severe (OR=2.3; 95% CI: 1.7, 3.0)
disabilities had higher odds of having unmet needs in this area. There is mixed
evidence in terms of the association of severity of disability or illness and
non-adherence to medication. However, there is some consistency in evidence
showing that complex regimens or experiencing adverse side effects (Aljofan et al., 2023), or the presence of
certain conditions, such as depression (Stewart et al., 2023), can increase the
risk of non-adherence.

Persons with disabilities who encountered
barriers to accessibility were at an increased risk of experiencing unmet needs
for medication. Both those who experienced a low rate (OR=1.4; 95% CI: 1.1, 1.7)
or high rate (OR=1.9; 95% CI: 1.5, 2.5) of barriers because of their condition
had higher odds of having unmet needs for medication than those who experienced
no barriers to accessibility. Barriers to communication between health care
providers and persons with disabilities can lead to medication nonadherence
behaviours (Goh et al., 2017).   

Prevalence of unmet needs for assistive aids or devices

Overall, unmet needs for assistive aids or
devices were experienced by 22.7% of persons with disabilities. There was some
variation in the proportion of those with unmet needs by type of aid or device.
Among those with hearing disabilities, 31.0% reported having at least one unmet
need for a hearing-related aid or device (Chart 3). Close to one in ten (9.8%)
persons with seeing disabilities reported an unmet need for a seeing-related
aid or device, while 14.1% of those with physical disabilities (this includes
mobility, flexibility or dexterity disabilities) reported an unmet need for a
physical aid or device. Unmet needs for cognitive aids were reported by 12.2%
of those with a learning or developmental disability.

Chart 3 start

Data table for Chart 3

Data table for chart 3

Table summary
The information is grouped by Type of assistive aids or devices (appearing as row headers), Percent and 95% confidence interval, calculated using lower and upper units of measure (appearing as column headers).

Type of assistive aids or devices	Percent	95% confidence interval
		lower	upper
Notes: Includes those who indicated they need an assistive aid or device but do not have it. Respondents could have reported unmet needs for more than one type of assistive aid or device. For different types of assistive aids and devices, proportions were calculated based on persons with related disability types. Source: Statistics Canada, Canadian Survey on Disability, 2022.
Hearing aids or assistive devices	31.0	28.6	33.6
Seeing aids or assistive devices	9.8	8.5	11.2
Physical aids or assistive devices	14.1	12.9	15.3
Cognitive aids or assistive devices	12.2	10.6	13.9
Other aids or assistive devices	12.2	11.5	13.0

Chart 3 end

Among all persons with disabilities, 12.2%
reported an unmet need for an “other” type of assistive aid or device. The most
commonly reported specific types of “other” aids or devices included
electrotherapy device for pain (26.7%), supportive devices, such as therapeutic
cushions or special chair (25.9%), orthopaedic footwear (24.3%) or a cell
phone, smartphone or smartwatch with specialized features or apps (20.1%).

Unmet needs for
assistive aids or devices varied with age as those aged 45 to 64 years (24.8%)
and those aged 65 year and older (25.6%) were more likely to have unmet needs
in this area than those aged 15 to 24 years (17.7%) (Table 1.2). When examined by
household living arrangement, couples with (19.2%) and without (20.8%) children
were less likely to have unmet needs for assistive aids or devices, compared
with those with no spouse or children (25.8%).

Racialized persons with disabilities (25.7%)
were more likely to report unmet needs in this area than their non-racialized,
non-Indigenous counterparts (21.8%). The prevalence of unmet needs for assistive
aids or devices was higher among Indigenous persons with disabilities (28.4%),
compared with non-Indigenous persons with disabilities (22.4%). Immigrants (26.3%)
were more likely to experience unmet needs in this area than non-immigrants (21.8%).

Unmet needs for assistive aids or devices were
associated with labour force status, education and income among persons with
disabilities. Unemployed persons with disabilities (22.8%) and those not in the
labour force (27.2%) were more likely to have unmet needs in this area,
compared to employed persons with disabilities (18.2%). Those with a
post-secondary education were less likely to have unmet needs for assistive aids
or devices, where 22.4% of those with a trade certificate or college diploma
and 18.6% of those with a bachelor’s degree or higher experienced unmet needs,
compared with 25.0% of those with a high school diploma or less. Experiencing
unmet needs in this area was more prevalent in lower income groups as the
proportion of persons with disabilities with unmet needs for assistive aids or
devices increased from 17.7% among those in the highest income quintile to 29.2%
among those in the lowest income quintile.

Health status was linked to the prevalence
of unmet needs for assistive aids or devices, where those with negative
self-rated health (32.4%) had almost twice the rate of unmet needs in this area
than those with positive self-rated health (17.0%). Persons with disabilities
who experienced loneliness (28.7%) were also more likely to report unmet needs
for assistive aids or devices than their counterparts who did not report being
lonely (18.5%).

Severity of disability was highly
correlated with unmet needs for assistive aids or devices (25.6%). For example,
individuals with very severe disabilities were four times as likely to have
unmet needs in this area, compared with those with mild disabilities (44.6% vs.
10.7%). Those with fluctuating, recurrent or progressive limitations
were more likely to have unmet needs for assistive aids or devices than those
with continuous limitations (17.1%).

The rate of unmet needs for assistive aids
or devices increased with the number of barriers to accessibility that were
encountered by persons with disabilities. Compared with those who experienced
no barriers (10.0%), those who experienced a lower (20.0%) and higher (37.0%)
than average number of barriers to accessibility were more likely to have unmet
needs in this area. Unmet needs for assistive aids or devices were more likely
among housebound individuals (33.5%) than their non-housebound counterparts (17.1%).

Key factors associated with the likelihood of having unmet
needs for assistive aids or devices

Unmet needs for assistive
aids or devices were associated with being aged 45 or older, identifying as a
racialized group, identifying as Indigenous and being in the first or third
income quintile (Table 2.2). While no gender differences were observed in the
descriptive analysis, the results of the model showed a lower likelihood of
experiencing unmet needs for assistive aids or devices among women (OR=0.9; 95%
CI: 0.8, 1.0). Conversely, while differences in unmet needs emerged by place of
residence, household living arrangement, labour force status and educational
attainment in the descriptive analysis, these differences did not persist when
all other factors were held constant.

Needs for assistive aids or devices have
been shown to increase with age and while women are often more likely to need
aids or devices, men often have a higher rate of access to these supports (WHO, 2022). However, many individuals report unmet
needs for the aids and devices they require (WHO,
2022). Given that high out-of-pocket costs are frequently cited as a barrier in
the area of access to aids or devices, the impact of income on unmet needs was
anticipated (Boot et al., 2018). The results of higher odds for unmet needs for
assistive aids or devices among racialized or Indigenous persons with disabilities
mirror previous results (Lindsay & Tsybina, 2011) and could be linked to difficulties
with communication with their service providers or with their sociocultural
beliefs decreasing the acceptance of the use of assistive devices (Chan &
Marsack-Topolewski, 2022; Orellano-Colón et al., 2016; Parette & Scherer,
2004).   

Increased disability severity, experiencing
episodic limitations and encountering barriers to accessibility were associated
with increased odds of having unmet needs for assistive aids or devices. When
controlling for all other variables, no significant differences emerged for
self-rated health, social isolation or housebound status.

Compared with persons with mild
disabilities, the odds of experiencing unmet needs for assistive aids or
devices were higher among those with moderate (OR=1.6; 95% CI: 1.3, 1.9),
severe (OR=2.4; 95% CI: 2.0, 2.9) or very severe (OR=3.7; 95% CI: 3.0, 4.6)
disabilities. Individuals with fluctuating, recurrent or progressive
limitations (OR=1.4; 95% CI: 1.2, 1.7) were at a higher risk of having unmet
needs in this area, compared with those with continuous limitations. Those with
more complex or more severe limitations can face additional challenges to gain
access to all the assistive products they need across different domains of
functioning. In one study, youth with more severe impairments were more likely
to report unmet needs for assistive devices, compared with youth with mild
impairments (Lindsay & Tsybina, 2011).

The odds of experiencing unmet needs for assistive
aids or devices were higher among those who faced barriers to accessibility.
For example, those encountering a higher than average number of barriers to
accessibility had three times the odds (OR=3.0; 95% CI: 2.4, 3.7) of having
unmet needs in this area than those who experienced no barriers. Difficulties
with care staff, complicated processes to obtain necessary devices,
difficulties with communication of information about devices, or stigma around
use of a device have all been identified as barriers to access for assistive
aids or devices (Mishra et al., 2024).

Prevalence of unmet needs for help with everyday activities

In 2022, 32.7% of persons with disabilities
had unmet needs for help with everyday activities because of their condition.
This help could come from a variety of sources including family, friends or
organizations. The most commonly reported unmet needs for help were related to
help with heavy household chores (21.5%), everyday housework (14.4%) and
getting to appointments or running errands (10.5%) (Chart 4).

Chart 4 start

Data table for Chart 4

Data table for chart 4

Table summary
The information is grouped by Type of help (appearing as row headers), Percent and 95% confidence interval, calculated using lower and upper units of measure (appearing as column headers).

Type of help	Percent	95% confidence interval
		lower	upper
Notes: Includes those who indicated they need help but do not receive it and those who did not receive enough help. Respondents could have reported more than one type of unmet need for help with daily activity. Estimates were calculated based on the total population of persons with disabilities. Source: Statistics Canada, Canadian Survey on Disability, 2022.
Heavy household chores	21.5	20.6	22.5
Everyday housework	14.4	13.6	15.2
Getting to appointments or running errands	10.5	9.8	11.3
Preparing meals	8.4	7.8	9.1
Looking after personal finances	4.9	4.4	5.5
Personal care	3.3	2.9	3.7
Basic medical care at home	2.0	1.7	2.4
Moving around inside residence	1.8	1.5	2.2

Chart 4 end

Unmet needs for
help with everyday activities varied by age, gender, immigrant status,
Indigenous group and household composition. The proportion of those with unmet
needs for everyday activities increased with age as 22.0% of youth aged 15 to
24 years had unmet needs in this area, compared with 38.0% of those aged 65
years and older (Table 1.2). Women (37.7%) were more likely than men (26.0%) to
report unmet needs in this area. A higher proportion of those in one parent
families (41.5%) reported unmet needs for help with everyday activities, when
compared with those with no spouse and no children (35.5%), while couples with
(28.6%) and without (30.8%) children were less likely to have unmet needs for
help.

Immigrants with
disabilities (36.1%) were more likely than non-immigrant persons with
disabilities (31.9%) to have unmet needs for help with everyday activities.
Indigenous persons with disabilities (37.8%) were more likely to have unmet
needs in this area than non-Indigenous persons with disabilities (32.5%).

When looking at employment, education and
income, there were once again differences in terms of unmet needs for help with
everyday activities. Employed persons with disabilities were less likely to
report unmet needs in this area (25.0%), compared with those who were not in
the labour force (40.9%). Those with a bachelor’s degree or higher were less
likely to have unmet needs for help with everyday activities (30.1%) than those
with a high school diploma or less (33.5%). Unmet needs varied by income as
those in the lowest income quintile were more likely to have unmet needs (40.2%)
than those in the highest income quintile (24.4%).

The prevalence of unmet needs for help with
everyday activities was higher among those with negative self-rated health (49.2%)
as compared with those with positive self-rated health (24.0%). Loneliness was
also linked to unmet needs for help as those who experienced loneliness (43.4%)
were more likely to report such unmet needs than those who did not report being
lonely (25.8%).

As disability severity increased, so did
the proportion of persons with disabilities who experienced unmet needs with
help with everyday activities: 14.4% among those with mild disabilities, 28.8%
among those with moderate disabilities, 45.7% among those with severe
disabilities and 62.9% among those with very severe disabilities. When looking
at episodic disability status, those who experienced fluctuating, recurrent or
progressive limitations were more likely to have unmet needs for help (36.3%)
than those who experienced continuous limitations (26.3%).

The more barriers to accessibility that
were experienced by persons with disabilities in different areas of their life,
the more likely they were to have unmet needs related to help with everyday
activities. The rate of unmet needs varied from 13.1% among those who
experienced no barriers, to 30.9% among those who experienced a lower number of
barriers and 52.5% among those who experienced a higher number of barriers. A
higher proportion of those who reported being housebound due to their condition
had unmet needs for help with everyday activities (54.2%), compared with those
who were not housebound (22.3%).

Key factors associated with the likelihood of having unmet
needs for help with everyday activities

After controlling
for the other covariates, the odds of having unmet needs for help with everyday
activities were higher among older age groups, as the odds were over twice as
high for those aged 65 years and older (OR=2.5; 95% CI: 1.9, 3.2) than for
those aged 15 to 24 years (Table 2.2). Women (OR=1.6; 95% CI: 1.4, 1.8) with
disabilities continued to be more likely than men to have unmet needs in this
area. Households with children were more likely to have unmet needs as couples
with children (OR=1.4; 95% CI: 1.1, 1.7) and one parent families (OR=1.4; 95%
CI: 1.1, 1.8) had higher odds of experiencing unmet needs for help when
compared with those with no spouse or children.

Previous research indicates higher need
levels and more unmet needs for support among older age groups (Albuquerque,
2022). Older individuals tend to have more disability types (Hébert at al.,
2024) that could require multiple types of care or help, which could result in
them having a higher likelihood of having unmet needs. In addition, a person’s
social network tends to shift or decrease with age, leading to less available
resources for assistance (Wrzus et al., 2013). Much of the existing literature
points to women having higher levels of social support compared to men, while
still finding higher unmet needs among women (Scharf et al., 2025; Trezzini et al., 2019). An increased awareness of needs and help seeking behaviour may
result in increased likelihood of unmet needs in the area of formal or informal
support.

Higher education and lower income were
associated with increased odds of having unmet needs for help with everyday
activities. Those with a bachelor’s degree or higher
were more likely to report unmet needs in this area than those with high school
diploma or less (OR=1.4; 95% CI: 1.2, 1.7). Persons with disabilities in the lowest income quintile
(OR=1.4; 95% CI: 1.1, 1.7) were more at risk for experiencing unmet needs for
help, compared with those in the highest income quintile. The findings related
to lower income and increased unmet needs are well documented (Spiers et al.,
2022; Trezzini et al., 2019), however the connection between unmet needs and
education seems to have mixed results. In some cases, the link between
education and unmet needs for help was not clear (Spiers et al., 2022), while
in other instances lower education levels were found to be associated with higher
unmet needs (Scharf et al., 2025).

Consistent with existing research (Spiers et al., 2022), lower perceived health (OR=1.3; 95% CI: 1.1, 1.5) was associated
with increased odds of having unmet needs in the area of help with everyday
activities, compared with higher perceived health status. Persons with
disabilities have higher rates of loneliness and lower perceived social support (Emerson et al., 2021) and studies have
found loneliness was associated with increased risk of unmet needs for care (Dahlberg
& McKee, 2016). Consistent with this research, the current study found
increased odds of having unmet needs for help among persons with disabilities
who reported loneliness. There is most likely a reciprocal relationship as access
to support and companionship can mitigate feelings of loneliness and exclusion.

Disability severity and episodic disability
status were predictors of the likelihood of having unmet needs for help with everyday
activities. The odds of having unmet needs were almost four times higher among
those with very severe disabilities (OR=3.9; 95% CI: 3.1, 4.8), compared with
those with mild disabilities. In addition, those with fluctuating, recurrent or
progressive limitations had higher odds of experiencing unmet needs than those
with continuous limitations. Individuals with more severe impairments have been
shown to be less likely to have natural support networks than those with less
severe impairments (Friedman, 2020). Research shows that those with more
complex needs tend to rely on support professionals (van Asselt-Goverts et al.,
2015), however many persons with disabilities report greater satisfaction with
informal support for everyday challenges but rank satisfaction with service
providers as more important than informal support (Blažeka Kokorić et al., 2012).

When all other variables were held
constant, both housebound status and encountering barriers to accessibility
were associated with unmet needs for help with everyday activities. Those who
faced a high number of barriers to accessibility were at a higher risk of unmet
needs for help with everyday activities when compared to those who experienced
no barriers to accessibility. Research has demonstrated that barriers related
to lack of information, transportation, communication, or negative attitudes have
been linked to access issues for support services (Grills et al., 2017; Maart
& Jelsma, 2014).

Persons who considered themselves
housebound had 1.8 (95% CI: 1.6, 2.1) times higher odds of experiencing unmet
needs for help than those who were not housebound. Often housebound individuals
experience greater difficulties within the area of activities of daily living
while also reporting low social support (Charlson et al., 2008). A higher
amount of caregiving support per week is linked to an increased ability to
leave the home environment (Reckrey et al., 2020).

Conclusion

Using data from the 2022 Canadian Survey on
Disability, this study demonstrated the relationship of a variety of sociodemographic
and disability or accessibility-related factors on the unmet needs for
disability supports among persons with disabilities. Across all areas of unmet
needs, severity of disability and encountering barriers to accessibility were
associated with an increased odds of experiencing unmet needs, pointing to the
importance of condition-specific issues and the removal and prevention of
barriers within environments and systems. The other health and
disability-related characteristics were significant predictors in most of the
areas of unmet needs as well. Lower self-rated health status and loneliness
were associated with unmet needs within health care services, medication and
help with everyday activities. Episodic disability status was associated with
unmet needs for health care services, assistive aids or devices and help with everyday
activities, while housebound status was a predictor of unmet needs for health care
services and help with everyday activities.

Age was another consistently significant
factor, with variation in the direction of the relationship, as older
individuals had higher odds of unmet needs for health care services, assistive
aids or devices and help with everyday activities but lower odds of having
unmet needs for medication. Similarly, gender was a common factor across the
unmet needs areas with women being more likely to experience unmet needs for
health care services, medication and help with everyday activities, while being
less likely to encounter unmet needs for aids or devices.

Certain aspects of socioeconomic status
were predictors in each area of unmet needs. Lower income was a predictor of
unmet needs for assistive aids or devices and help with everyday activities,
with a particularly strong association with unmet needs for medication, owing
to how survey questions in this area were cost specific. Those not in the
labour force had lower odds of having unmet needs for health care services and
medication, while unemployed individuals had higher odds of unmet needs for medication.
Higher levels of education were associated with higher odds of having unmet
needs for health care services and help with everyday activities, but lower
odds of unmet needs for medication.

The current study did have some
limitations. The CSD refers only to the Canadian population living in private
households and does not cover those living in institutions, which could
represent a large proportion of persons with disabilities who require support
or services. Additionally, since proxy cases are collected in cases where the
respondent is not able to complete the survey themselves, proxy cases could
represent a proportion of those with more severe or complex disability
statuses, that would then not be included in the analysis. It is also important
to note that the income information used in this report reflects year of 2020,
which carries the complexities that came with the COVID-19 pandemic. Given the strong
association of disability severity on each unmet need area, analysis was done
to better understand the specific factors that were associated with milder and
more severe disabilities separately, however due to sample size restrictions,
the variability in the estimates made it difficult to detect real differences
among the various characteristics.

The results of this study highlight the
need for a service delivery approach that addresses the multitude of factors
that could impact social participation and health outcomes of persons with
disabilities. In addition, it provides information on specific elements that
could be targeted for different support areas to improve access for persons
with disabilities. Future research could explore the experiences of unmet needs
for different disability types, as certain conditions or combinations of
conditions can lead to complex needs that require tailored and coordinated
care. Examining effective interventions for addressing unmet needs,
particularly in relation to the severity of disability or for specific
population groups, could offer important insights.

Appendix

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