The study also reports that it has become increasing common for younger stroke patients to have one or more of the disease’s five leading risk factors: high blood pressure, diabetes, obesity, tobacco use and lipid (cholesterol) disorders. Significant percentages of young adults hospitalized for stroke have three to five of those risk factors.
These are troubling findings. For although deaths due to this disease have fallen significantly over the last 50 years, stroke is the fifth leading cause of death in the United States, killing more than 130,000 people each year. It is also the leading cause of long-term disability.
Those numbers could — indeed, should — be much lower, for 80 percent of strokes are considered preventable.
“The young adult population is experiencing an increase in a serious yet largely preventable disease,” the authors of the current study write.
Their findings “should serve as a call to action to focus on improving the health of younger adults,” theye add.
For the study, the researchers used a large, nationally representative database of hospitalization discharge information (billing data) to examine the stroke rates and prevalence of risk factors among adults aged 18 to 64 between the years 1995 and 2012.
They looked at the data for both types of stroke: ischemic and hemorrhagic. An ischemic stroke — sometimes called a “brain attack” — occurs when a blood clot blocks a blood vessel within the brain. Almost 90 percent of strokes are this type. A hemorrhagic stroke occurs when a weakened blood vessel in the brain ruptures.
The data revealed that the rate of ischemic stroke increased significantly for people aged 18 to 54. That was particularly true for men. Between 1995 and 2012, the ischemic stroke rate doubled for adult men under the age of 44. Much of that increase occurred after 2003. Among men aged 35 to 44, for example, the rate jumped a stunning 41.5 percent between 2003 and 2012.
The rate of hemorrhagic strokes, however, remained basically unchanged during that same time period.
The study’s authors point to an increase in stroke-related risk factors as the key reason for the rising incidence of ischemic stroke among younger adults. Their data revealed that young adults hospitalized for stroke have rates of traditional stroke risk factors that are almost twice as high as those of their peers in the general population.
For example, diabetes occurs in about 12 percent of people in the general population aged 45 to 64, yet about 40 percent of the people in the study in that age group who were hospitalized for stroke had diabetes.
Caveats — and a call to action
In a commentary accompanying the study, two doctors question the study’s use of billing data to analyze trends in stroke rates. They suggest that increased use of advanced imaging technologies may be identifying strokes in younger people that might have been missed in past years. Changes in hospital coding practices — labeling a transient ischemic attack (a temporary blockage of blood to the brain), or TIA, as a stroke, for example — may also be involved, they add. Hospitals have a financial incentive to code a TIA as a stroke, they point out.
“If these findings represent a true epidemiologic trend, understanding the reasons underlying this trend and seeking to reverse it should be a leading priority of the stroke community,” write the comentary’s authors, Drs. James Burke and Lesli Skolarus of the University of Michigan, Ann Arbor. “However, it is not yet clear whether such urgent action is needed.”
The lack of clear information on this topic is frustrating, they add. “It is startling that in a country that spends almost 20% of the largest gross domestic product on the planet on health care, we cannot say with confidence whether the fifth leading cause of death in the United States is increasing or decreasing in the young,” the doctors write. “Yet, that is precisely our state of affairs.”
The authors of the current study counter, however, that it’s unlikely advanced imaging influenced their study’s findings, noting that the use of such technologies among younger adults was common by 2005.
Their study, they therefore conclude, “should prompt a sense of urgency among young 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.”
FMI: You can read the study and the commentary in full on the JAMA Neurology website. You’ll find information about stroke and its prevention, including a guide to how to recognize the signs of a stroke, on the Centers for Disease Control and Prevention (CDC) website.