Stroke Rates Rise Sharply Among Younger Adults

 While the stroke rate among older adults in the US declined over the past 30 years, the rate among individuals aged 20-54 years nearly doubled, largely due to an increase in ischemic strokes, a new study showed.

Despite the increase in the stroke rate in this age group, there was a slight decrease in short-term mortality between 1993 and 2020, which investigators said suggests that more young adults are living with post-stroke disability.

“While stroke has traditionally been considered a disease of older adults, our findings show that stroke is becoming increasingly common in younger adults,” lead investigator Emily Fisher, MD, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, said in a news release.

“At the same time, more people are surviving these strokes, which means more younger adults may be living with the long-term effects of stroke,” Fisher added.

The study was published online on September 23 in Neurology.

Growing Burden

Current data suggest that 1 in 7 strokes happen among people younger than 50 years. Over the past few decades, stroke incidence among young adults has risen due to an increase in cardiovascular risk factors and sedentary lifestyles.

In this study, the investigators analyzed hospitalized stroke cases across the Greater Cincinnati and Northern Kentucky region in 1993-1994, 1999, 2005, 2010, 2015, and 2020. Cases were identified by International Classification of Diseases, Ninth and 10th Revisions (ICD-9 and ICD-10) codes and reviewed by stroke-trained physicians.

Data from patients’ medical records as well as the National Death Index were used to assess 30-day case fatality rates (CFRs). For this study, young stroke cases were defined as strokes among people aged 20-54 years.

Ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) subtypes were included in the analysis, while transient ischemic attacks were excluded.

Logistic regression models were used to test trends in 30-day CFRs over time, adjusting for age, sex, and race. Incidence rates were assessed using US Census data, and trends were tested over time with linear regression models.

Role of Substance Use?

There were 2076 first-ever strokes among younger adults, with an increase from 33.9 cases per 100,000 in 1993-1994 to 62.18 cases per 100,000 in 2020 (P = .04). During the same period, the stroke incidence rate declined among older adults from 618.78 cases per 100,000 to 453.04 cases (P = .02).

Ischemic stroke appeared to be driving the increase in stroke among younger adults, with the rate of ischemic stroke nearly doubling from 23.8 cases per 100,000 to 47.3 cases per 100,000 (P = .02).

From 1993 to 2020, incidence of high blood pressure, diabetes, and atrial fibrillation became more common in younger adults. Substance use also rose in this population, from 4.6% in 1993 to 40.2% in 2020, largely due to an increase in marijuana consumption.

“Whether substance use is playing a causal role in the rising burden of stroke in the young, it is important to identify it as a highly common comorbidity in this population with potential negative health consequences,” the investigators wrote.

There were no significant changes observed over time for moderate alcohol use (defined as two or more alcohol servings per day) and tobacco use.

More Strokes, Lower Mortality

The 30-day CFR decreased from 11.7% to 9.4% (P = .002) during the time. When the investigators assessed the 30-day CFR by stroke subtype, they found that this slight decline was mostly among those with ICH and SAH.

The findings suggest that although young adults are experiencing more strokes, they are also more likely to survive, which may lead to increased long-term stroke disability, the investigators noted.

A limitation of the study was that they did not include people without stroke to identify how the trends in risk factors relate to the growing stroke rates. In addition, the population included only Black and White individuals and therefore was not representative of other races.

“Our findings highlight the importance of identifying and managing stroke risk factors early in adulthood,” Fisher said. “Additional research is needed to better understand what is driving these trends and how they can be reversed.”

This research was supported by the Greater Cincinnati/Northern Kentucky Stroke Study. See the study for a full list of author disclosures.

https://www.medscape.com/viewarticle/stroke-rates-rise-sharply-among-younger-adults-2026a1000zj2