In a setback in the fight against stoke, federal researchers reported Sept. 1 that the rate of hospitalizations for ischemic stroke in children and young adults rose between 1995 and 2008. The study also found that risk factors for stroke increased in this age group. Results were published in the September issue of the Annals of Neurology.
Stroke is the third leading cause of death in the U.S. with lifetime costs of more than $140,000 for ischemic stroke. Hospitalization rates and stroke-related mortality for adults who experience strokes have dropped since the late 1990s. But rates of stroke risk factors such as obesity, hypertension, diabetes, alcohol use have been increasing.
Given these trends, Mary G. George, MD, a medical officer at Division of Heart Disease and Stroke Prevention at the Centers for Disease Control and Prevention (CDC) and colleagues wanted to explore the prevalence of acute stroke hospitalizations and risk factors for strokes in children and young adults. To do so they analyzed hospital discharge data between 1995 and 2008 from the Nationwide Inpatient Sample (INS), the largest all-payor hospital inpatient care database in the U.S., for patients between 5 and 44 years old.
Using ICD-9-CM codes, they identified diagnoses of subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) and ischemic stroke hospitalizations. They estimated risk factor prevalence through ICD-9-CM codes.
They found that the rate of ischemic stroke hospitalizations in children and young adults who were between 15 and 44 years old increased up to 37 percent during the study period. Hospitalizations for ischemic stroke in boys and men rose dramatically: 51.6 percent in the 5- to 14-year- old group; 45.6 percent in the 15- to 34-year-old group; and 50.4 percent in the 35- to 44-year-old group. Female patients between 15 and 34 and between 35 and 44 had smaller relative increases. Associated risk factors also increased.
“Rates of traditional risk factors for stroke among children and young adults are increasing, and smoking rates have failed to decline,” the authors wrote. “We identified increases in ischemic stroke hospitalizations associated with increases in these traditional risk factors among adolescents and young adults.”
They reported that nearly a third of those who experience ischemic stroke in the 15- to 34-year-old group and more than half in the 35- to 44-year-old group had hypertension. Diabetes diagnoses were recorded for a quarter of the 35- to 44-year-old group.
George and colleagues emphasized that the study involved a large national cohort but was limited in several ways, including changes in coding, diagnostic practices and participation in the INS over the sample time frame. They pointed out that the study could identify the prevalence of risk factors but not the cause of stroke. They added that the costs and morbidity of stroke in a younger population are great, but potentially avoidable.
“Our results from national surveillance data accentuate the need for public health initiatives to reduce the prevalence of risk factors for stroke among adolescents and young adults,” George summarized in a statement.