Cardiovascular Disease Risk Among Young Adults with Disabilities: A Nationwide Cohort Study

Cardiovascular disease (CVD) risk may be under-recognized in young adults living with long-standing disability. We evaluated whether disability is associated with incident CVD risk in adults aged 20-39 years beyond conventional risk factors and whether risk varies by disability type, severity, and duration.

We analysed 7,682,700 Korean adults aged 20-39 years without prior CVD who underwent national health screening (2009-2014). Disability was ascertained using a standardized, medically certified national certification system. Individuals with disabilities (n = 91,500; physical, brain lesion-related, sensory, or communication disabilities) were exact-matched 1:10 to non-disabled peers by age, sex, and index year. The primary endpoint was a composite of hospitalisation for myocardial infarction, stroke, or heart failure, or cardiovascular death.

Over a median follow-up of 11 years, 7,925 participants developed CVD. CVD incidence was higher among individuals with disabilities than among matched controls (102.9 vs 70.2 per 100,000 person-years), and disability remained associated with increased risk after comprehensive adjustment for sociodemographic factors, comorbidity burden, health behaviours, and cardiometabolic risk factors (HR 1.34; 95% CI 1.25-1.44). Risk varied by disability type (highest for brain lesion-related disability) and increased with greater severity. Similarly, CVD risk increased gradually with longer disability duration.

In young adults, disability is associated with higher incident CVD risk independent of conventional risk factors, with heterogeneity by type and severity- and duration-related gradients. These findings support earlier preventive attention and monitoring within disability care pathways in young adulthood.