Background and Objectives: Emerging literature indicates that stroke incidence among U.S. citizens ages 18 to 45 have increased in recent years. An increase in young strokes leads to a the disproportionately large economic impact due to decreased productivity earlier compared to older stroke victims. Some literature has revealed significant differences in young stroke occurrence, with the Midwest seeing one of the most significant increases in young strokes. Risk factors for a stroke at a younger age include high blood pressure, obesity, smoking, and diabetes. The objective of this study was to review trends on ischemic strokes, especially between the ages of 18 and 45, as well as risk factors for young strokes.
Methods: A retrospective review of acute ischemic stroke patients was conducted from 2009-2016 in 11 Midwest states (IN, IL, IA, KS, MI, MN, MO, ND, SD, and WI) using the American Stroke Association’s Get With The Guidelines (GWTG) Stroke database. Annual trends using rate per 10,000 were reviewed for age (18-45, 46-65, 66-85, and >85), obesity, smoking status, drug use/abuse, hypertension, and diabetes mellitus.
Results: Over the course of 8 years, there was no significant difference in stroke rate per 10,000 in any of the age groups (18-45, 46-65, 66-85, and >85). Focusing on the 18-45-year age group, the rate of stroke per 10,000 in 2009 was 604.7, 609.9 in 2010, 618.8 in 2011, 592.3 in 2012, 581.3 in 2013, 572.7 in 2014, 588.9 in 2015, and 608.2 in 2016. There was no significant difference in the rate per 10,000 for smoking, hypertension, and diabetes. There was a significant difference (p<0.05) in the rate per 10,000 for obesity and drug use/abuse. Obesity increased from a rate of 0.16 per 10,000 ischemic strokes in 2009 to 2111.4 per 10,000 in 2016. Drug use/abuse increased from a rate of nearly 0 per 10,000 ischemic strokes in 2009 to 655 per 10,000 in 2016.
Conclusions: A majority of ischemic strokes are still happening in older individuals, with no significant differences in young strokes being reported from the Midwest region GWTG data from 2009-2016. Given the conflicting research in young stroke incidence, additional research needs to be completed. Future studies should look to determine if there are any differences in stroke rate based on urbanization category.