Why More Younger Adults Are Having Strokes — and What Providers Can Do

The incidence of stroke is increasing among young adults over time, while case-fatality rates (CFRs) are decreasing, according to a study published online Sept. 23 in Neurology.

Emily R. Fisher, M.D., from the University of Cincinnati, and colleagues characterized the incidence rates, 30-day CFRs, and the burden of stroke risk factors over time in young adults (aged 20 to 54 years) in a five-county region. Hospitalized stroke cases were ascertained in six study periods: July 1993 to June 1994, and calendar years 1999, 2005, 2010, 2015, and 2020.

The researchers identified 2,076 first-ever strokes in young adults across all study periods. Over time, hypertension, diabetes, atrial fibrillation, and substance use were more common. There was an increase in stroke incidence rates over time among young adults (33.90 cases/100,000 person-years in 1993-1994 to 62.18 cases/100,000 person-years in 2020), while a decline was seen in older adults (618.78 to 453.04 cases/100,000 person-years, respectively). Ischemic stroke seemed to drive the increase in stroke incidence, with an almost doubling of incidence rate (23.8 to 47.3 cases/100,000 person-years in 1993-1994 and 2020, respectively). Young adults had a modest decline in 30-day CFR (11.7 to 9.4 percent in 1993-1994 and 2020, respectively), which was driven by intracerebral hemorrhage and subarachnoid hemorrhage (27.5 to 21.2 percent and 27.9 to 18.6 percent, respectively).

“Our findings highlight the importance of identifying and managing stroke risk factors early in adulthood,” Fisher said in a statement.

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Stroke Risk Doesn’t Start at Older Age

Many assume that stroke is a condition that only happens to older people. However, younger patients may have traditional vascular risk factors that warrant attention well before typical stroke screening conversations.

The Centers for Disease Control and Prevention (CDC) reported that about 1 in 7 strokes occur among adolescents and young adults ages 15 to 49.

The new evidence emphasizes the need for earlier identification and management of modifiable risk factors in young adults, including high blood pressure, diabetes, obesity, smoking, and hyperlipidemia.

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For Black Patients, Earlier Risk Assessment May Be Especially Important

Black adults have a significantly higher risk of stroke overall than white adults. The CDC reported that the risk of a first stroke is nearly twice as high among non-Hispanic Black adults. Research involving younger adults has found a higher stroke risk among Black participants, with high blood pressure playing an important role.

Instead of treating stroke as a condition to address in later adulthood, clinicians may need to consider earlier and more consistent attention to cardiovascular risk factors in younger Black patients. Clinicians should also examine how social and structural barriers may contribute to young Black adults having strokes.

Don’t Assume Stroke Is Unlikely Because a Patient Is Young

A patient’s young age shouldn’t automatically lower clinical suspicion when neurological symptoms are present. Additionally, young adults may not recognize stroke symptoms as an emergency, so clinicians should remain alert to presentations that warrant immediate evaluation. While stroke may be more prevalent in older adults, clinicians should still assess younger patients — particularly when they have hypertension or other modifiable risk factors — and recommend preventive measures to lower the risk of an event.

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