Strokes Increasing Among Young Adults, Study Finds

More young and middle-aged adults are suffering strokes, as are residents of low- and middle-income countries, new research indicates.

Globally, the number of stroke cases has increased 25 percent among adults aged 20 to 64 during the last two decades, according to data published in two papers in The Lancet and The Lancet Global Health. Strokes in this age group now make up 31 percent of the total number of strokes, compared with 25 percent before 1990.

Worldwide, more than 83,000 people aged 20 and younger are affected by stroke annually; an estimated 0.5 percent of all strokes occur in this age group.

Researchers claim the increase in strokes among younger populations is likely to continue unless effective preventive strategies are implemented. They also expect the number of strokes to possibly double by 2030.

“The worldwide stroke burden is growing very fast and there is now an urgent need for culturally acceptable and affordable stroke prevention, management and rehabilitation strategies to be developed and implemented worldwide,” Valery Feigin, M.D., director of the National Institute for Stroke and Applied Neurosciences at AUT University, Auckland, New Zealand, who worked on the research, said in a statement.

Stroke Burden Could Double

The international research team estimated the incidence, prevalence, and premature death and disability caused by stroke in all 21 regions of the world for 1990, 2005, and 2010 using 119 relevant studies: 58 from high-income countries and 61 from low- and middle-income countries.

They found the average age of people with stroke has slightly increased, but most of the burden of stroke (overall illness and death) has shifted from people older than 75 years to people 74 years and younger. This group accounts for 62 percent of new strokes, 45 percent of deaths, and 72 percent of illness and disability. These figures significantly are greater in low- and middle-income countries, the investigators discovered.

While the rate (age-standardized per 100,000 population) of stroke-related deaths has declined worldwide over the last two decades, the actual numbers of stroke-related deaths rose to 5.9 million — a 26 percent increase.

In addition, the number of people suffering a first stroke increased significantly to 16.9 million in 2010 (up 68 percent), the number of stroke survivors surged to 33 million (an 84 percent increase), and stroke-related associated disability and illness rose to 102.2 million (up 12 percent). Left unchecked, stroke deaths, survivors, and disability and illness will more than double by 2030 to 12 million, 70 million, and 200 million, respectively, the researchers warn.

The Role of Income

Richer countries, naturally, fared better with the disease over the last 20 years than their less affluent counterparts. The data show age-standardized incidences of stroke fell 12 percent, premature death rates plunged 37 percent, and illness and disability rates plummeted 36 percent in high-income countries over the last two decades. The researchers attribute the decreases to improved education, prevention, and care, including smoking cessation, control of blood pressure, acute stroke units, and diagnosis.

In low- and middle-income countries, however, the opposite is true; stroke mortality is 42 percent higher and is associated with more disability and illness (46 percent greater) than in high-income countries. This is in part due to a rise in the prevalence of such risk factors as an unhealthy diet, high blood pressure, obesity, physical inactivity.

The data also show that 61.5 percent of the disability and 51.7 percent of stroke deaths resulted from hemorrhagic stroke, despite being less common than ischemic stroke. Those most affected by hemorrhagic stroke are people younger than 75 years and those living in low-income and middle-income countries, where incidence of hemorrhagic stroke has risen by around 19 percent.

“Urgent preventive measures and acute stroke care should be promoted in low-income and middle-income countries, and the provision of chronic stroke care should be developed worldwide,” wrote Maurice Giroud, Agnès Jacquin, and Yannick Béjot from the Department of Neurology, University of Burgundy, Dijon, France.

In a comment in The Lancet Global Health, Graeme J. Hankey, MD, from the University of Western Australia, Perth, wrote that “population-based mass strategies to reduce consumption of salt, calories, alcohol, and tobacco by improving education and the environment will complement high-risk strategies of identifying those at risk of haemorrhagic (and ischaemic) stroke, thus empowering these individuals to improve their lifestyle behaviours and, if necessary, lower their mean blood pressure and blood pressure variability with appropriate doses of antihypertensive drugs.”