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Cited by 355Acute Ischemic Stroke ManagementCardiovascular Health and Risk FactorsCerebrovascular and Carotid Artery Diseases

Prevalence of cardiovascular risk factors and strokes in younger adults

Open access
George, Mary G., Tong, Xin, Bowman, Barbara A.·2017·JAMA Neurology
DOI 10.1001/jamaneurol.2017.0020PMC PMC5559660
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Abstract

Importance: While stroke mortality rates have decreased substantially in the past 2 decades, this trend has been primarily limited to older adults. Increasing trends in stroke incidence and hospitalizations have been noted among younger adults, but there has been concern that this reflected improved diagnosis through an increased use of imaging rather than representing a real increase. Objectives: To determine whether stroke hospitalization rates have continued to increase and to identify the prevalence of associated stroke risk factors among younger adults. Design, Setting, and Participants: Hospitalization data from the National Inpatient Sample from 1995 through 2012 were used to analyze acute stroke hospitalization rates among adults aged 18 to 64 years. Hospitalization data from 2003 to 2012 were used to identify the prevalence of associated risk factors for acute stroke. Acute stroke hospitalizations were identified by the principal International Classification of Diseases, Ninth Revision, Clinical Modification code and associated risk factors were identified by secondary International Classification of Diseases, Ninth Revision, Clinical Modification codes for each hospitalization. Main Outcomes and Measures: Trends in acute stroke hospitalization rates by stroke type, age, sex, and race/ethnicity, as well as the prevalence of associated risk factors by stroke type, age, and sex. Results: The 2003-2004 set included 362 339 hospitalizations and the 2011-2012 set included 421 815 hospitalizations. The major findings in this study are as follows: first, acute ischemic stroke hospitalization rates increased significantly for both men and women and for certain race/ethnic groups among younger adults aged 18 to 54 years; they have almost doubled for men aged 18 to 34 and 35 to 44 years since 1995-1996, with a 41.5% increase among men aged 35 to 44 years from 2003-2004 to 2011-2012. Second, the prevalence of stroke risk factors among those hospitalized for acute ischemic stroke continued to increase from 2003-2004 through 2011-2012 for both men and women aged 18 to 64 years (range of absolute increase: hypertension, 4%-11%; lipid disorders, 12%-21%; diabetes, 4%-7%; tobacco use, 5%-16%; and obesity, 4%-9%). Third, the prevalence of having 3 to 5 risk factors increased from 2003-2004 through 2011-2012 (men: from 9% to 16% at 18-34 years, 19% to 35% at 35-44 years, 24% to 44% at 45-54 years, and 26% to 46% at 55-64 years; women: 6% to 13% at 18-34 years, 15% to 32% at 35-44 years, 25% to 44% at 45-54 years, and 27% to 48% at 55-65 years; P for trend < .001). Finally, hospitalization rates for intracerebral hemorrhage and subarachnoid hemorrhage remained stable, with the exception of declines among men and non-Hispanic black patients aged 45 to 54 with subarachnoid hemorrhage (13.2/10 000 to 10.3/10 000 hospitalizations and 15.8/10 000 to 11.5/10 000 hospitalizations, respectively). Conclusions and Relevance: The identification of increasing hospitalization rates for acute ischemic stroke in young adults coexistent with increasing prevalence of traditional stroke risk factors confirms the importance of focusing on prevention in younger adults.

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  • Reproductive factors, such as fertility therapy use, may be a sex-specific risk marker or mediator to appreciate when deciding on risk reduction strategies in women.

    “In an era in which sex-based differences in CVD are increasingly recognized, reproductive factors, such as fertility therapy use, may be a sexspecific risk marker or mediator to appreciate when deciding on risk reduction strategies in women (5,37).”

    From Cardiovascular Risk Following Fertility Therapy (2017) · cites this paper as [37]

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Research works printed but not linked: 4

  1. [7]National Center for Health Statistics Health, United States, 2007, with chartbook on trends in the Health of Americans Hyattsville, MD 2007 20698068
  2. [8]National Center for Health Statistics Health, United States, 2014, with special feature on adults aged 55–64 Hyattsville, MD 2014 26086064
  3. [9]HCUP NIS Database Documentation Healthcare Cost and Utilization Project (HCUP) 10 2015 Agency for Healthcare Research and Quality Rockville, MD www.hcup-us.ahrq.gov/db/nation/nis/nisdocumentation.jsp 21413206
  4. [10]HCUPnet, Healthcare Cost and Utilization Project Agency for Healthcare Research and Quality Rockville, MD http://hcupnet.ahrq.gov/ 21413206

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Authors
George, M. G., Tong, X., & Bowman, B. A.
Affiliations
Centers for Disease Control and Prevention (US)
Corresponding author
George, Mary G.
ORCID
Venue
JAMA Neurology
Publisher
American Medical Association (AMA)
Published
2017-06-01
Volume
74
Issue
6
Pages
695
ISSN
2168-6149 (ISSN-L)
DOI
10.1001/jamaneurol.2017.0020
PMC
PMC5559660
OpenAlex
W2607464869
Cited by
355
References
21
Citations by year
2026: 22 · 2025: 32 · 2024: 45 · 2023: 42 · 2022: 54 · 2021: 53 · 2020: 45 · 2019: 29 · 2018: 25 · 2017: 8
FWCI
22.92
Type
journal article
Language
en
Open access
Locations
  • JAMA Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health (CC999999)
Topics
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
Keywords
acute ischemic stroke, stroke risk factors, young adults, hypertension, diabetes mellitus, obesity, tobacco use, lipid metabolism disorders, stroke incidence trends, racial and ethnic disparities, sex differences, National Inpatient Sample
MeSH terms
Adolescent, Adult, Cardiovascular Diseases, Brain Ischemia, Female, Hospitalization, Humans, Male, Middle Aged, Risk Factors, United States, Prevalence, Stroke, Young Adult

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