Scientists have reported an almost twofold increase in the incidence of strokes before the age of 55
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- Scientists have reported an almost twofold increase in the incidence of strokes before the age of 55
The incidence of first strokes among people aged 20-54 has increased by about 83% in less than three decades. The main contribution was made by ischemic strokes, in which the blood supply to a part of the brain is disrupted due to blockage of a vessel. At the same time, the proportion of patients who died in the first 30 days after a stroke decreased. What is known about the reasons for growth, why improving survival does not eliminate the problem, and what factors require attention at a young age is in the Izvestia article.
Which means an increase of almost two times
The study covered the Greater Cincinnati region and northern Kentucky. The authors studied the first-ever strokes in residents aged 20 to 54 years, registered in six periods: from July 1993 to June 1994, and then in 1999, 2005, 2010, 2015 and 2020.
We are talking about comparing several time slices, and not about continuous monitoring of the same group of people for 27 years. In total, during these periods, the researchers identified 2,076 first strokes in the representatives of the selected age group. The cases were checked by doctors specializing in stroke. In 1993-1994, the incidence was 33.9 cases per 100,000 person-years, and in 2020 - 62.2. The increase between the beginning and the end of the period was about 83%.
Therefore, it's not just about increasing the number of registered patients. It is the frequency of the first strokes per population that has increased.
"Although stroke has traditionally been considered a disease of the elderly, our results show that it is becoming more common among young adults," said study author Emily Fisher, a specialist in vascular neurology at the University of Cincinnati.
At the same time, the word "young" in this work has specific boundaries — from 20 to 54 years old. The results obtained cannot be automatically transferred to teenagers or considered as a separate assessment for twenty-year-olds: the overall indicator unites people of different ages.
Which strokes have become more frequent
The main increase occurred in ischemic strokes. Their frequency increased from 23.8 to 47.3 cases per 100,000 person-years, almost doubling. In ischemic stroke, the vessel through which blood flows to the brain is blocked. The nervous tissue stops receiving enough oxygen and nutrients, as a result of which it can quickly become damaged. The specific consequences depend on which structures are affected and how extensive the lesion is.
Other types of stroke have a different mechanism. Intracerebral hemorrhage occurs directly in the brain tissue. In subarachnoid hemorrhage, blood enters the space between the arachnoid and soft membranes of the brain.
The researchers did not find a comparable increase in the frequency of these two types. Therefore, the general conclusion about the increase in morbidity requires clarification: different forms of stroke varied differently.
It also follows that it would be wrong to explain the trend only by vascular ruptures. The main increase is associated with a violation of blood supply due to their blockage, and the search for causes should take into account this mechanism.
A different trend was found in the elderly
An additional result of the work shows that age-related changes are not limited to the overall increase in strokes in the entire population. On the contrary, the incidence among residents aged 55 and older decreased over the same period: from about 619 to 453 cases per 100,000 person-years.
However, the absolute indicator in the older group was still significantly higher than in people aged 20-54. Therefore, the study does not confirm the conclusion that "stroke has become predominantly a disease of the young."
The problem is the multidirectional dynamics. A decrease in the incidence in older people may be combined with an increase in people who still have decades of work and family life ahead of them. At the same time, general statistics can hide the deterioration of the situation in a particular group.
The authors have not established which changes explain this discrepancy. Their results show the need to study prevention and risk factors separately at different ages, rather than considering the improvement of the overall picture to be the same for everyone.
Blood pressure, diabetes, and heart rhythm disorders
Stroke patients were more likely to have high blood pressure, diabetes, and atrial fibrillation over time. The latter is a violation of the heart rhythm, which can contribute to the formation of blood clots. If such a blood clot moves with the bloodstream into the vessels of the brain and blocks one of them, an ischemic stroke occurs.
High blood pressure and diabetes are also known risk factors. According to the US Centers for Disease Control and Prevention, hypertension often occurs without noticeable symptoms. Therefore, normal well-being in itself does not mean that there is no vascular risk.
But finding a more frequent combination of diseases and explaining the increase in strokes to them are different research tasks. The work did not have comparable data on people without stroke, which would allow us to assess how much the prevalence of these conditions has changed in the entire population of the region.
For example, an increase in the proportion of patients with hypertension among stroke survivors does not yet show how much of the increase in morbidity was caused by hypertension. To do this, you need to know how often she met with other residents and how other circumstances changed.
The detection of diseases is also important. The authors separately note that an increase in the number of reported cases of atrial fibrillation may reflect both a real increase and a more active use of heart rate monitoring. The contribution of each explanation requires further evaluation.
Why data on substance use does not provide a simple answer
One of the most notable changes concerned the documented use of psychoactive substances. Among stroke patients, this figure increased from 4.6% in 1993-1994 to 40.2% in 2020. A significant portion of the increase was related to records of marijuana use.
However, these 40.2% do not mean that the substances caused such a proportion of strokes. The indicator describes the availability of relevant information in medical records, rather than the established cause of each case.
The order of data collection is also important. The researchers point out that part of the growth may have been due to more detailed documentation and changes in patient screening practices in later years.
The use itself is also not a homogeneous factor: the specific substance and the specific effects are important. The combined indicator does not allow us to determine the contribution of each of them.
Finally, without comparable information about people who have not suffered a stroke, it is impossible to determine how much the change in this indicator explains the increase in morbidity. Therefore, the work provides grounds for additional research, but not for reducing the entire trend to a single cause.
The survival rate has improved, but it's not a full recovery yet.
In parallel with the increase in morbidity, the researchers found a decrease in the 30-day mortality rate. After age, race, and gender were taken into account, the proportion of patients who died within a month of a stroke decreased from 11.7% to 9.4%.
The difference is 2.3 percentage points. This is an outcome indicator among people who have already had a stroke, rather than the frequency of deaths in the entire population.Thus, the study describes two different processes.: stroke has become more frequent, but the short-term chances of surviving it have improved. One result does not cancel out the other.
In addition, survival in the first 30 days does not mean full recovery and does not describe a person's condition after a year or several years. A stroke can leave movement, speech, memory, and other functions impaired.
"At the same time, more and more people are experiencing these strokes, which means more young adults can live with their long—term consequences," Fisher emphasized.
For a person of working age, such consequences may include returning to work, independence, and family responsibilities. At the same time, the study did not establish exactly how many participants faced long—term limitations: the possibility of an increase in the number of people with stroke consequences is a conclusion about the potential burden, and not the dynamics of disability measured in this work.
According to the U.S. National Heart, Lung, and Blood Institute, recovery from a stroke can take weeks, months, and years. Some patients recover completely, while others retain long-term or lifelong impairments. Rehabilitation may include the restoration of speech, movement, and daily life skills, as well as psychological assistance.
Why can't the result be automatically transferred to the whole world?
The work is based on the population of one American region. This makes it an important source of information on long-term dynamics, but it does not turn the 83% increase into an indicator for all countries.
Morbidity and its registration may be influenced by the prevalence of risk factors, the availability of medical care, and diagnostic features. To assess the trend in Russia or another country, appropriate data is needed.
There is also a time limit: the last point studied dates back to 2020. The publication date in 2026 does not mean that scientists have measured the incidence over the past six years. The work shows the changes between specific periods from 1993 to 2020.
Her result also does not establish a single reason for the growth. The identified changes in blood pressure, diabetes, heart rate, and substance use help identify areas for further research, but their contributions have yet to be shared.
What is changing in the approach to prevention
According to the authors, the results reinforce the importance of early detection and control of risk factors. Stroke prevention should not begin only after reaching old age.
"Our results highlight the importance of identifying stroke risk factors and working with them in early adulthood. More research is needed to better understand what causes these trends and how they can be reversed," said Fisher.
Common preventive measures include controlling blood pressure and diabetes, quitting smoking, being physically active enough, and preventing excessive alcohol consumption. The detected cardiac arrhythmias require a separate medical assessment. These measures are based on already known risk factors, even if the exact explanation for the increase in morbidity has not yet been found.
Timely care for the stroke itself is equally important. Its symptoms may include sudden weakness or numbness of the face, arm, or leg, especially on one side of the body, impaired speech or comprehension, severe visual impairment, loss of balance, and an unusually severe headache. Such symptoms require an immediate ambulance call, regardless of age.
Even the rapid disappearance of symptoms does not exclude a dangerous circulatory disorder: a transient ischemic attack may manifest itself in this way, which also requires an urgent medical assessment.
The increasing incidence of strokes among people aged 20-54 poses two related challenges for medicine: to prevent new cases and to ensure long-term recovery for those who have already suffered the disease. Improving short-term survival becomes especially significant when it is followed by the opportunity to return to independent living.
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