Disability patterns and subjective cognitive decline among adults with and without cancer history

Background : Subjective cognitive decline (SCD) is a self-reported experience of worsening confusion or memory loss, which increases the risk of dementia and may be influenced by disabilities. This study compared disability types and counts and SCD of people with or without a cancer history and examined the potential association between disability counts and SCD. Methods : We used cross-sectional survey data from the 2024 Behavioral Risk Factor Surveillance System Cognitive Decline module. The sample included adults aged ≥45 years, with (n=12,601) and without (n=61,575) cancer history. The outcome was self-reported SCD confusion or memory loss worsening in the past 12 months. Disability types included limitations in hearing, vision, mobility, self-care, and independent living, and were categorized by count as 0, 1, 2, 3-5 disabilities. We conducted descriptive statistics and multivariable logistic regression, incorporating an interaction term between cancer history and disability count. Results : About 73.0% of participants were aged ≥75 years, 53.2% were female, and 66.1% self-identified as White. Overall, 15.4% self-reported SCD, with higher prevalence among cancer survivors than those without cancer history (19.7% vs. 14.7%, p≤.001). The most prevalent disability type was mobility among adults with (31.0%) and without (20.4%) a cancer history. Among cancer survivors, SCD prevalence increased with disability count: 11.8% with no disabilities, 21.5% with one, 32.8% with two, and 47.2% with 3-5 disabilities. Similar patterns were observed in the non-cancer group: 8.9%, 19.8%, 30.2%, and 47.2%, respectively. In subgroup regression models, cancer survivors with 3-5 disabilities have 341% increased odds of reporting SCD compared to those without disabilities (AOR=4.41, 95% CI 3.07-6.33). Individuals without a cancer history who have 3-5 disabilities have 403% higher odds of reporting SCD compared to their no-disability counterparts (AOR=5.03, 95% CI 4.05-6.25). In the full model, both disability count and cancer status were independently associated with SCD; however, the interaction term was not statistically significant, suggesting that cancer status does not influence the relationship between disability count and SCD. Conclusions : We estimated that SCD affects many individuals with (1.1million) and without (4.8million) cancer history aged ≥45 years. Routine screening for cognitive health, particularly for individuals with disabilities, is crucial for the early identification, proactive management, and tailored care of health needs in the adult population that may potentially lower the risk for dementia. Building personalized and need-based cognitive support resources, such as decision aids, checklists, digital and manual reminders, will help to promote care to this vulnerable group.