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.