Stroke in the Young: Incidence, 30-Day Case Fatality Rates, and Risk Factors Over Time in a Population-Based Study.

Abstract (English)

BACKGROUND AND OBJECTIVES: 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 (<i>p</i> < 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 <i>p</i> = 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 <i>p</i> = 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 <i>p</i> = 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 <i>p</i> = 0.002), driven by intracerebral hemorrhage (27.5% in 1993/4 to 21.2% in 2020, trend <i>p</i> = 0.03) and subarachnoid hemorrhage (27.9% in 1993/4 to 18.6% in 2020, trend <i>p</i> = 0.09). DISCUSSION: 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.