Adolescent learning disability and premature mortality: A 30-year prospective study of gender differences

Learning disabilities (LD)-defined in the U.S. as specific learning disorders (e.g., dyslexia, attention-related difficulties) and distinct from intellectual disability-are associated with educational disadvantage, psychosocial stress, and constrained healthcare access. Evidence on whether adolescent LD predicts premature mortality in adulthood remains limited.

To examine the association between adolescent LD and premature mortality through early to mid-adulthood and assess whether these associations differ by gender.

Data were drawn from 17,478 U S. adolescents in Wave I (1994-1995) of the National Longitudinal Study of Adolescent to Adult Health, linked to National Death Index records through 2023. Cox proportional hazards models with school-clustered robust standard errors estimated hazard ratios (HR) for all-cause and cause-specific (disease, external, suicide) mortality. Sex-stratified models and LD × sex interactions assessed sex differences.

Adolescents with LD had significantly elevated all-cause premature mortality (adjusted HR = 1.79 [1.47-2.18]). Associations were strongest for disease-related mortality (HR = 2.14 [1.61-2.85]) and elevated for external causes (HR = 1.57 [1.13-2.18]); suicide was non-significant. Sex-stratified analyses revealed substantially stronger effects among females than males (all-cause HR = 2.29 vs 1.58; disease-related HR = 2.87 vs 1.72); the LD × male interaction was statistically significant (p < 0.01).

Adolescents with LD experience markedly elevated mortality through mid-adulthood, particularly from disease-related causes and especially among females. The findings position LD as a marker of cumulative social disadvantage shaped by stigma, exclusion, and unmet healthcare needs, calling for sustained, gender-sensitive support across educational, healthcare, and social systems.