Stroke in the Young
Incidence, 30-Day Case Fatality Rates, and Risk Factors Over Time in a Population-Based Study.
A population-based study spanning nearly 30 years reveals that stroke incidence in young adults (20–54 years) has nearly doubled, rising from 33.9 to 62.2 per 100,000 person-years, driven primarily by ischemic stroke. This increase coincides with a marked rise in traditional vascular risk factors, including hypertension, diabetes, atrial fibrillation, and substance use. Although 30-day case fatality rates have modestly declined, the findings underscore the critical need for early cardiovascular risk assessment and prevention strategies in younger populations.
Background
Despite an overall decline in incidence rate, the burden of stroke may be rising in young adults. We aimed to characterize the incidence rates, 30-day case fatality rates (CFRs), and the burden of stroke risk factors over time in young adults in a representative population-based study of stroke.
Methods
Using validated methods, hospitalized stroke cases in a 5-county region were ascertained and adjudicated by stroke-trained physicians in 6 study periods: July 1993-June 1994 and calendar years 1999, 2005, 2010, 2015, and 2020. Stroke in the young was defined as those occurring among individuals who were aged 20-54 years. Incidence rates were generated using US Census data standardized to the 2010 population, and trends were tested with linear regression. Temporal trends in 30-day CFR were evaluated with logistic regression after adjusting for age, race, and sex.
Results
Across all study periods, there were 2,076 first-ever strokes in young adults. Hypertension, diabetes, atrial fibrillation, and substance use were more common over time (p < 0.001). The stroke incidence rate increased in young adults over time (33.90 cases/100,000 person-years in 1993/4 to 62.18 cases/100,000 person-years in 2020, trend p = 0.04), while declining in older adults (618.78 cases/100,000 person-years in 1993/4 to 453.04 cases/100,000 person-years in 2020, trend p = 0.02). The rise in stroke incidence appeared driven by ischemic stroke, with an almost doubled incidence rate of 23.8 cases/100,000 person-years in 1993/4 to 47.3 cases/100,000 person-years in 2020 (trend p = 0.02). There was a modest decline in the 30-day CFR in young adults (11.7% in 1993/4 to 9.4% in 2020, trend p = 0.002), driven by intracerebral hemorrhage (27.5% in 1993/4 to 21.2% in 2020, trend p = 0.03) and subarachnoid hemorrhage (27.9% in 1993/4 to 18.6% in 2020, trend p = 0.09).
Conclusions
The incidence of stroke in young adults is rising over time, while the CFR simultaneously declines. This coincides with a rise in both traditional vascular risk factors and substance use.
