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

AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.