Ischemic stroke hospitalizations among younger adults increased 30% or more in recent years

From 2003 to 2012, acute ischemic stroke hospitalization rates increased 30 percent among women and 41.5 percent among men who were between 35 and 44 years old, according to a database analysis.

During that same time period, the prevalence of stroke risk factors increased and the prevalence of having three to five risk factors increased among adults (18 to 64 years old) who were hospitalized for acute ischemic stroke.

Lead researcher Mary G. George, MD, MSPH, of the Centers for Disease Control and Prevention (CDC) in Atlanta, and colleagues published their results online in JAMA Neurology on April 10.

The researchers noted that stroke was the third leading cause of death in the U.S. from 1938 to 2007, but it dropped to fifth in 2013. However, they added that the rate of decline in mortality among adults 65 and older was approximately double the rate of decline among adults from 45 to 64 years old.

For this analysis, they evaluated the National Inpatient Sample, a publicly available database of hospital inpatient stays in the U.S. The number of states that participated in the database increased from 37 in 2003 to 44 in 2012. They examined stroke hospitalization rates for adults between 18 and 64 years old.

From 2003-2004 to 2011-2012, acute ischemic stroke hospitalization rates increased for all races and ethnicities and for men and women in the 18 to 34, 35 to 44 and 45 to 54 years old age groups except for non-Hispanic blacks and other race groups for ages 18 to 34 years. For adults between 55 and 64 years old, only Hispanics had a significant increase in acute ischemic stroke hospitalization rates.

The hospitalization rate increased 74.8 percent for men aged 18 to 34 years, increased 65.7 percent for women aged 18 to 34 years, increased 91 percent for men aged 35 to 44 years and increased 53.6 percent for women aged 35 to 44 years.

In addition, there was an increasing prevalence of hypertension, lipid disorders, diabetes, tobacco use and obesity across all age groups and both sexes. The prevalence of three or more traditional risk factors (hypertension, diabetes, lipid disorders, obesity and tobacco use) nearly doubled among all age groups for both men and women. Meanwhile, the prevalence of none of these risk factors decreased, according to the researchers.

During the study, acute ischemic stroke hospitalizations among adults from 18 to 64 years old increased from an average of 141,474 per year in 2003- 2004 to 171,386 per year in 2011-2012. Meanwhile, hospitalizations for subarachnoid hemorrhage declined from an average of 17,598 per year in 2003-2004 to 15,974 per year in 2011-2012. Meanwhile, there were 22,097 hospitalizations per year for intracerebral hemorrhage in 2003-2004, which increased slightly to 23,545 per year in 2011-2012.

The researchers mentioned a few limitations of their analysis, including that they did not have information on stroke severity or the cause of stroke. They also could not rule out that increased use of advanced imaging over time influenced the results. In addition, they could not account for family history, the use of estrogen medications and other risk factors.

“The significant increases in ischemic stroke hospitalizations and associated traditional stroke risk factors from 2003-2012, which is consistent with rates from 1995-1996 and 2007-2008 among those experiencing an acute stroke should serve as a call to action to focus on improving the health of younger adults,” the researchers wrote. “Preventing and controlling stroke risk factors among young working-age adults can save lives, reduce disability, decrease societal health care costs, and improve the quality of life for hundreds of thousands of Americans and their families. Identifying the high and rising prevalence of stroke risk factors among younger adults presenting with acute stroke should prompt a sense of urgency among younger adults, public health practitioners, clinicians, and policy makers to engage adolescents and their families, as well as younger adults, to identify and treat stroke risk factors and promote opportunities that allow for healthy lifestyles to prevent the tragedy of stroke at such early ages.”