Factors Associated With the Rising Trend in Self-Reported Cognitive Disability Among U.S. Adults Aged 18-39 From 2013-2024.

OBJECTIVE

Building on our prior Behavioral Risk Factor Surveillance System analysis identifying adults aged 18-39 as the primary driver of the national increase in self-reported cognitive disability, we examined factors associated with this rise using 2013-2024 U.S. BRFSS data.

METHODS

We analyzed U.S. Behavioral Risk Factor Surveillance System data, excluding 2020 due to poor survey response, to assess trends in self-reported cognitive disability among adults aged 18-39, excluding and including respondents with depression. Cognitive disability was defined as serious difficulty concentrating, remembering, or making decisions due to a physical, mental, or emotional condition. We compared younger adults with versus without cognitive disability across sociodemographic, socioeconomic, health, and mental health characteristics. Analyses incorporated survey weighting to yield U.S. nationally representative estimates.

RESULTS

Cognitive disability prevalence increased from 5.1% in 2013 to 9.8% in 2024 (93% increase; p < 0.001). Including respondents with depression, prevalence increased from 10.0% to 17.8% (16.2 million individuals). Among younger adults with cognitive disability, employment increased (55.6% to 65.1%), lack of health insurance declined (35.7% to 19.7%), smoking decreased (28.7% to 14.1%), and physical inactivity decreased (26.9% to 22.3%). Point estimates for hypertension, hyperlipidemia, asthma, diabetes, and stroke prevalence were also lower. In contrast, frequent poor mental health (≥ 14 days/month) increased from 26.6% to 33.2%. In sensitivity analyses excluding depression and any poor mental health days, prevalence still increased from 2.8% to 5.2% (p < 0.001).

INTERPRETATION: From 2013-2024, self-reported cognitive disability among younger United States adults nearly doubled despite improving socioeconomic and cardiometabolic indicators, highlighting a growing burden of perceived or functional cognitive difficulty.