Stroke, which is also known as a cerebrovascular accident, is a form of cardiovascular disease that affects the arteries of the brain.
A stroke occurs when an artery bringing oxygen and nutrients to the brain is blocked by plaque and blood clots (ischemic stroke), or when an artery in the brain bursts (hemorrhagic stroke). Approximately 795,000 strokes occur annually in the United States. Ischemic strokes account for about 87% of all strokes, while hemorrhagic strokes account for about 13%. In addition to being the leading cause of long-term disability, stroke also causes about 150,000 deaths annually in the U.S. While the majority of strokes occur in older individuals, about 10% of strokes occur in people under the age of 40.
In this blog, we will examine stroke hospitalization rates over time in various countries, with a particular emphasis on younger individuals.
The first study that we will discuss was published in the Journal of the American Heart Association in 2016. United States hospital discharge data from January, 2000 through December, 2010 was obtained. Overall annual rates of ischemic stroke were reported, as well as annual rates among younger individuals aged 25 to 44 years. The overall hospitalization rate for ischemic stroke decreased from 250 per 100,000 persons in 2000 to 204 per 100,000 in 2010. However, as shown in the Figure below, among younger individuals the hospitalization rate for ischemic stroke increased from 16 per 100,000 persons in 2000 to 23 per 100,000 in 2010. This represents a 43.8% increase!
A more recent study was published in 2021. Participants included the 156,000 citizens of Dijon, a city in Eastern France, who were studied between 1985 and 2017. Hospitalization rates for ischemic stroke among individuals under the age of 45 were examined.
As seen in the Figure below, ischemic stroke hospitalizations among young adults decreased slightly from 1985 through 2002, increased sharply between 2003 through 2012, and then leveled off between 2013 through 2017.
The most recent study regarding stroke rates in young adults was published in the Journal of the American Medical Association in August, 2022. A total of 94,567 participants from Oxfordshire, England were followed between 2002 and 2018. Younger individuals were defined as those under the age of 55, while older individuals were defined as those ages 55 and over. When comparing the time periods of 2002-2010 versus 2010-2018, stroke rates increased by 67% in younger individuals and decreased by 15% in older individuals.
Therefore, despite a decrease in overall ischemic stroke hospitalization rates, there has been a significant increase in such hospitalization rates among young adults over the past few decades.
Scientists believe that there are multiple reasons for this trend. First, rates of obesity, hypertension, metabolic syndrome, and type 2 diabetes have risen sharply among young adults since the mid-1980’s; all of these conditions are risk factors for ischemic stroke. Additionally, physical inactivity, vaping, and alcohol abuse are common in young people and have tended to increase over time. Those behaviors increase the risk of ischemic stroke. Lastly, the use of illicit drugs such as Fentanyl and other opioids has increased substantially among young people over the past quarter century. The use of these and other illicit drugs is strongly associated with stroke risk.
In conclusion, there is overwhelming scientific evidence that rates of ischemic stroke have increased substantially among younger individuals over the past few decades. It is important to note that this stroke increase among the younger population occurred well before the COVID-19 pandemic and COVID-19 vaccine availability.
Public awareness of the warning signs of stroke is relatively poor. The warning signs include the following:
- Sudden weakness or numbness of the face, arm, or leg on one side of the body
- Sudden dimness or loss of vision, particularly in one eye
- Loss of speech, trouble talking or understanding speech
- Mental confusion; sudden loss of consciousness
- Sudden severe headache with no known cause
- Unexplained dizziness or sudden falls
If you observe one or more of these warning signs, don’t wait! Call 911 right away.
American Heart Association. (2022). Heart disease and stroke statistics-2022 update. Circulation. 145(8):e153-e639.
Ramirez, L., et al. (2016). Trends in acute ischemic stroke hospitalizations in the United States. J Am Heart Assoc. doi: 10. 1161/JAHA.116.003233
Bejot, Y., et al. (2021). Temporal trends in the incidence of ischemic stroke in young adults: Dijon Stroke Registry. Neuroepidemiology. 55:239-244. doi: 10. 1159/000516054
Linxin, L., et al. (2022). Association of younger vs older ages with changes in incidence of stroke and other vascular events, 2002-2018. JAMA. 328(6):563-574.