Racial and Ethnic Disparities In Cognitive Disability Among U.S. Young Adults across COVID-19 Pandemic Periods: The Moderating Role of Educational Attainment

Background and Purpose: Cognitive functioning in young adulthood has long-term implications for economic productivity, mental health, and well-being. A recent study reported a rising trend in self-reported cognitive disability over the past decade in the U.S., particularly among young adults (Wong et al., 2025). The COVID-19 pandemic introduced unprecedented stressors (e.g., social isolation) and may have differentially affected cognitive disability across racial and ethnic groups of young adults. However, pandemic-associated changes in cognitive disability remain underexamined. Educational attainment is an important personal resource for cognitive health, yet little is known about how it interacts with racial and ethnic disparities in young adults’ cognitive disability across pandemic periods. This study examines: (1) whether cognitive disability prevalence among U.S. young adults changed across pre-pandemic (2018-2019), pandemic (2020-2023), and post-pandemic (2024) periods; (2) whether changes differed by race and ethnicity; and (3) whether educational attainment moderated racial and ethnic disparities in cognitive disability across pandemic periods.

Methods: We analyzed repeated cross-sectional data from the 2018-2024 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative annual survey. The study sample included young adults aged 18–29 across racial and ethnic groups: non-Hispanic White, non-Hispanic Black, Hispanic, Asian, American Indian/Alaska Native (AI/AN), and multiracial respondents. Cognitive disability was defined by the BRFSS as self-reported past-year experience of serious difficulty concentrating, remembering, or making decisions because of a physical, mental, or emotional condition. Covariates included age, sex, educational attainment, unmet medical need, physical activity, tobacco use, binge drinking, living arrangement, and self-rated health. Survey-weighted multivariate logistic regression models with interaction terms estimated racial and ethnic disparities in pandemic-related changes in cognitive disability, adjusting for covariates. Analyses were further stratified by educational attainment to examine its moderating role.

Results: Before the pandemic, cognitive disability prevalence was highest among multiracial (20.4%) and AI/AN (18.7%) young adults, followed by Hispanics (14.4%), non-Hispanic Whites (14.0%), non-Hispanic Blacks (13.3%), and Asians (6.7%). During the pandemic, prevalence significantly increased across all racial and ethnic groups; however, non-Hispanic Whites experienced greater increases than Blacks (p=.037) and Hispanics (p=.045). Post-pandemic prevalence remained elevated without significant recovery. Stratified analyses showed that pandemic-related racial and ethnic disparities in cognitive disability were concentrated among less-educated (≤high school education) young adults and were not observed among those with at least some college education. Among less-educated young adults, compared to Whites, pandemic-period increases in cognitive disability were significantly more pronounced among Asians (p=.033) but smaller among Blacks (p=.017). Furthermore, cognitive disability prevalence remained greater among less-educated multiracial group (p=.015) than among less-educated Whites in the post-pandemic period.

Conclusions and Implications: Findings suggest that educational attainment plays as a buffer against pandemic-related cognitive health risks in young adulthood. Less-educated multiracial young adults showed particular vulnerability following the pandemic, suggesting that resilience and recovery from pandemic stressors are not equally distributed across racial and ethnic groups. These findings underscore the need for targeted, culturally responsive interventions for racially and ethnically minoritized young adults, especially those with lower educational attainment, to prevent widening cognitive disability disparities following future public health crises.