Increased mortality risk for adults aged 25–44 years with long-term disability: A prospective cohort study with a 35-year follow-up of 30,080 individuals from 1984–2019 in the population-based HUNT study

Background: Differences in survival between groups may reflect avoidable and modifiable inequalities. This study examines the 35-year mortality risk for adults aged 25–44 years in the mid-1980s with disability due to vision, hearing, or motor impairment; physical illness; or mental health problems. Methods: This Norwegian study was based on data from the Trøndelag Health Study (HUNT1, 1984–86, and HUNT2, 1995–97) linked to tax-registry data for deaths before 15 November 2019. Mortality risk was estimated by Cox regression analysis adjusted for age and sex. Sensitivity analysis included the following possible mediators: education, work, living situation, body mass index, systolic blood pressure and smoking. Findings: Of the 30,080 HUNT1 participants aged 25–44 years, 5071 (16.9%) reported having disability. During the 35 years of follow-up, 1069 (21.1%) participants with disability and 3107 (12.4%) without disability died. Individuals with any type of disability had 62% higher mortality risk compared to those without a disability, adjusted by age and sex. The highest mortality risks were observed for disability due to severe motor impairment (HR=3.67, 95%CI=2.89–4.67) and severe mental health problems (HR=3.40, 95%CI=2.75–4.23) compared to those without these disabilities. Increased mortality risk was found for all the included disability types. The associations were somewhat mediated, especially by education, work and living situation. Interpretation: This study shows that among adults aged 25–44 years, the risk of death increases with disability of different types and severity levels, particularly for disability related to mental health problems or motor impairment. Funding: None.