‘Daunting’ trajectory of age at first stroke

By Eleanor McDermid, Senior medwireNews Reporter

The incidence of stroke in young people has increased over recent years, shows a US population-based study.

Stroke incidence was particularly high in young Black people, report Brett Kissela (University of Cincinnati College of Medicine, Ohio, USA) and colleagues in Neurology.

"These findings suggest that efforts need to be directed toward stroke awareness and education to reduce stroke incidence in young adults, particularly in minority communities," write Sally Sultan and Mitchell Elkind (Columbia University, New York, USA) in an editorial accompanying the study.

A consequence of stroke occurring at younger ages will be an overall increase in the burden of stroke-related disability, they note.

Kissela et al found that the gender-adjusted average age at first stroke in the Greater Cincinnati/Northern Kentucky region of the USA fell significantly between 1993-1994 and 2005, from 71.2 to 69.2 years. Likewise, the proportion of strokes occurring in people younger than 55 years rose from 12.9% to 18.6%.

The findings are in line with previous studies; however, the editorialists say that the increase may not be as large as reported, because of changes in imaging techniques over the years. Increasing use of magnetic resonance imaging, which is more sensitive than computed tomography, may result in the diagnosis of more strokes, they explain.

The researchers tried to allow for this by including cases based on clinical diagnoses, rather than imaging results, but Sultan and Elkind say that imaging findings will still have influenced physicians' final diagnostic decisions.

In Black people aged 20-54 years, the gender-adjusted incidence of stroke rose from 83 to 128 per 100,000 between 1993-1994 and 2005. The same increase was seen in White people, but the overall incidence was lower, rising from 26 to 48 per 100,000 people.

Over the same period, stroke incidence also rose in Black people aged 55-64 years, from 414 to 524 per 100,000, whereas it fell marginally in White people of the same age, from 237 to 209 per 100,000. Stroke incidence fell to some degree in all older age groups.

"Among the young, the increase in incidence suggests an unknown and potentially daunting future trajectory," say Sultan and Elkind.

"Replication of these findings in other US populations and internationally is crucial, and future studies will need to account for potential temporal trends in diagnostic testing while also teasing out causative factors."

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