Rising Cognitive Disability as a Public Health Concern Among US Adults: Trends From the Behavioral Risk Factor...

Cognitive disability-defined by the Behavioral Risk Factor Surveillance System (BRFSS) as serious difficulty concentrating, remembering, or making decisions because of a physical, mental, or emotional condition-has become the most commonly reported disability among US adults. This broad definition reflects a heterogeneous range of underlying causes and highlights the growing public health significance of cognitive disability in the population. Previous studies have identified disparities by race, age, and socioeconomic status, but few have examined how these patterns have evolved over the past decade. This study analyzes national trends in self-reported cognitive disability from 2013 to 2023 using BRFSS data, with a focus on differences across age groups, racial and ethnic populations, and key social determinants of health.

We conducted a retrospective analysis using data from the Centers for Disease Control and Prevention's Disability and Health Data System, which integrates nationally representative responses from US adults (aged ≥18 years) in the BRFSS from 2013 to 2023, excluding 2020 and participants who self-reported depression, to better identify nonpsychiatric cognitive impairment. The primary outcome was self-reported cognitive disability, defined as "serious difficulty concentrating, remembering, or making decisions." Survey-weighted logistic regression was used to model prevalence trends and examine associations with demographic and socioeconomic factors.

From 2013 to 2023, a total of 4,507,061 responses were included in the analysis. Apart from analyses focusing on strata of age, all estimates of cognitive disability were age-adjusted. Most respondents were aged 18-39 years (36.8%), identified as non-Hispanic White (60.9%), and had completed at least a high school education (87.3%). The age-adjusted self-reported cognitive disability prevalence in the United States rose from 5.3% (95% CI 5.1%-5.4%) in 2013 to 7.4% (95% CI 7.2%-7.6%) in 2023, with statistically significant increases beginning in 2016. The prevalence of cognitive disability among younger adults aged 18-39 years nearly doubled, increasing from 5.1% (95% CI 4.8%-5.3%) to 9.7% (95% CI 9.2%-10.2%), making this age group the primary driver of the overall rise in cognitive disability in the United States.

The disproportionate growth in cognitive disability among younger adults seems to be the primary driver of the overall national trend. These findings warrant further investigation, given their potential long-term implications for population health, workforce productivity, and health care systems.