Stroke is considered to be a problem that mainly affects older adults. However, a new study published in the journal Neurology has found that stroke rates among adults aged 20 to 54 nearly doubled over almost three decades. The research, which analysed data from the Greater Cincinnati and Northern Kentucky region in the US, highlights a worrying shift in the age group affected by this condition. The findings also show that more younger adults are surviving strokes than before, although many may face long-term health complications.

The study examined stroke cases between 1993 and 2020 and found that the increase was largely driven by ischaemic strokes, which happens when a blood clot or blockage interrupts blood flow to the brain. Researchers also observed that high blood pressure, diabetes, irregular heart rhythms and substance use became more common among younger adults who experienced strokes. The findings highlight the importance of recognising stroke risks earlier in life and understanding why younger adults are increasingly affected.

Emily R. Fisher, MD, of the University of Cincinnati and study author said, "While stroke has traditionally been considered a disease of older adults, our findings show that stroke is becoming increasingly common in younger adults. At the same time, more people are surviving these strokes, which means more younger adults may be living with the long-term effects of stroke."

Stroke Rates Increased By Nearly 83% Over 27 Years

The researchers identified 2,076 first-time strokes among adults aged 20 to 54 across the study periods. In 1993-1994, the stroke rate was 33.9 cases per 1,00,000 person-years. By 2020, it had increased to 62.2 cases per 1,00,000 person-years, an overall rise of approximately 83%. Person-years is a measure that accounts for the number of people being studied and the time they are observed. It helps researchers compare how frequently a condition occurs across different periods.

Interestingly, the trend among younger adults was different from that among older people. While stroke rates increased in the younger age group, they declined among older adults during the same period.

Ischaemic Strokes Accounted For Much Of The Cases

The study found that ischaemic strokes were largely responsible for the rising rates among younger adults. An ischaemic stroke occurs when a blood vessel supplying the brain gets blocked, usually by a blood clot. This prevents oxygen-rich blood from reaching parts of the brain, causing brain cells to become damaged.

The rate of ischaemic strokes among adults aged 20 to 54 increased from 23.8 cases per 1,00,000 person-years in 1993-1994 to 47.3 in 2020, almost doubling over the study period.

On the other hand, the researchers did not find comparable increases in two types of bleeding strokes: intracerebral haemorrhage, which involves bleeding inside the brain, and subarachnoid haemorrhage, which occurs in the space surrounding the brain.

High Blood Pressure And Diabetes

Researchers also found that several health conditions linked to stroke became more common among younger adults who experienced one. These included high blood pressure, diabetes and atrial fibrillation, a condition that causes an irregular heartbeat.

High blood pressure can damage blood vessels over time, increasing the risk of blockages and bleeding. Diabetes can also damage blood vessels and increase the risk of cardiovascular problems. Also, atrial fibrillation can cause blood to collect in the heart and form clots that may travel to the brain. Substance use was another finding. The proportion of younger stroke patients with documented substance use increased from 4.6% in 1993-1994 to 40.2% in 2020. Much of this increase was associated with marijuana use.

However, researchers cautioned that these findings do not prove that the risk factors caused the rise in stroke rates. Since the study did not include comparable health information from people who had not experienced strokes, it could not establish how much each factor contributed to the overall trend.

More Younger Adults Are Surviving Strokes

Despite the increase in stroke cases, the study found some encouraging changes in survival. The proportion of younger adults who died within 30 days of a stroke fell from 11.7% in 1993-1994 to 9.4% in 2020, after researchers accounted for differences in age, race and sex. The improvement was particularly noticeable among people who experienced bleeding strokes. This suggests that advances in medical care and stroke management may have helped improve short-term survival.

However, surviving a stroke does not always mean making a full recovery. Depending on the part of the brain affected and the severity of the damage, a person may experience difficulties.

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