Stroke under 55 rose as hypertension, diabetes and substance use rose

Design

Population-based epidemiological study, six periods 1993–2020

Population

2,076 first-ever strokes in adults aged 20–54 in a five-county US region

Primary outcome

Stroke incidence, 30-day case fatality and risk factor prevalence over time

Effect

Incidence 33.9 to 62.2 per 100,000; ischaemic 23.8 to 47.3; 30-day CFR 11.7% to 9.4%

A population-based study identified and adjudicated every hospitalised stroke in a five-county US region in six periods from 1993/4 to 2020, and examined 2,076 first strokes in adults aged 20 to 54. It was published on 23 September.

Stroke incidence in young adults rose from 33.9 to 62.2 per 100,000 person-years, while it fell in older adults from 619 to 453. The rise was driven by ischaemic stroke, which nearly doubled (23.8 to 47.3 per 100,000). Hypertension, diabetes, atrial fibrillation and substance use all became more common among young stroke patients. Thirty-day case fatality fell from 11.7% to 9.4%, mostly because haemorrhagic strokes became less often fatal.

This is observational and from one US region, so it shows a trend and an association with risk factors, not their causal share. Whether the same trend holds in India is not addressed here. The implication is that stroke prevention cannot wait until patients are older: the blood pressure and glucose checks that a young adult skips are where much of this begins.

• Check blood pressure and screen for diabetes in adults in their thirties and forties, not only in older patients.
• Treat hypertension in young adults with the same intent as in older patients.
• Ask about substance use as part of cardiovascular risk assessment in young adults.
• Counsel young patients with vascular risk factors that stroke is not a disease of old age only.

Why it matters

Stroke prevention aimed at older adults is missing a growing group of younger patients.

Don't overread it

This was observational; rising risk factors coincided with rising stroke but were not shown to cause it.

The statistics, in plain English

Incidence nearly doubled across 27 years in the young while falling in older adults. Trend tests were significant (p = 0.04 overall, 0.02 for ischaemic stroke), but the study measures change in one region and cannot show how much each risk factor contributed.

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