Inequalities in health and healthcare utilization among people with disabilities in Ethiopia: evidence from the 2021/2022 Ethiopian Socio-Economic Panel Survey

People with disabilities, on average, have higher healthcare needs than others in the population. However, evidence shows that they frequently face barriers to accessing healthcare services and incur greater costs when seeking care, although data is lacking for sub-Saharan Africa. This study aimed to assess inequalities in health status and healthcare utilization among people with disabilities in Ethiopia. This study used data from the 2021/22 Ethiopian Socio-Economic Panel Survey (ESPS) and included 17 181 respondents. Logistic regression models were employed for the analysis of the independent association between disability status and both reported illness and healthcare utilization, adjusting sequentially, first for predisposing factors (primarily age and sex) and then for additional variables. People with disabilities were more likely to report illness compared to those without disabilities (AOR = 2.91, 95% CI: 1.56–5.43). This pattern was consistent among both men (AOR = 3.06, 95% CI: 1.21–7.71) and women (AOR = 2.67, 95% CI: 1.26–5.68). People with disabilities also reported more frequent use of healthcare services (AOR = 1.49, 95% CI: 1.01–2.21). This association remained apparent among men with disabilities compared to those without disabilities (AOR = 1.99, 95% CI: 1.16–3.43), but not among women (AOR = 1.22, 95% CI: 0.67–2.24). Additionally, people with disabilities incurred higher mean annual healthcare expenditures (US$ 133.73) compared to those without disabilities (US$ 37.89, p = 0.04). People with disabilities in Ethiopia had greater healthcare needs than people without disabilities, which were not fully matched by increased levels of healthcare utilization, and they incurred higher healthcare costs, indicating systemic inequalities in health. A twin-track approach could help address these gaps and support the realization of the human rights of people with disabilities in Ethiopia. While healthcare needs and utilization were higher among people with disabilities in Ethiopia compared to those without, the increased utilization did not implicitly bridge the gap in unmet needs.Healthcare professionals, policymakers, and stakeholders must recognize the barriers that may lead to impaired health and hinder service utilization in order to improve health outcomes and quality of life.A twin-track approach that integrates disability considerations into general health services, alongside disability-specific targeted interventions, may help reduce health inequalities.Interventions to improve healthcare access for people with disabilities should address the higher healthcare costs incurred (e.g., through provision of health insurance programs, and subsidizing healthcare costs). While healthcare needs and utilization were higher among people with disabilities in Ethiopia compared to those without, the increased utilization did not implicitly bridge the gap in unmet needs. Healthcare professionals, policymakers, and stakeholders must recognize the barriers that may lead to impaired health and hinder service utilization in order to improve health outcomes and quality of life. A twin-track approach that integrates disability considerations into general health services, alongside disability-specific targeted interventions, may help reduce health inequalities. Interventions to improve healthcare access for people with disabilities should address the higher healthcare costs incurred (e.g., through provision of health insurance programs, and subsidizing healthcare costs).