First-time strokes among adults ages 20 to 54 in the Greater Cincinnati region nearly doubled between the early 1990s and 2020, according to a study published in Neurology, the medical journal of the American Academy of Neurology. The research, led by vascular neurology fellow Emily R. Fisher at the University of Cincinnati, draws on one of the longest-running stroke surveillance efforts in the country.
Researchers identified 2,076 first-ever strokes among younger adults using records from the Greater Cincinnati Northern Kentucky Stroke Study, which has tracked stroke cases across a five-county region since 1993. The overall stroke rate in that age group rose from 33.9 to 62.2 cases per 100,000 person-years between the 1993-94 and 2020 study periods. Nearly all of the increase came from ischemic strokes, caused by a blocked blood vessel, which climbed from 23.8 to 47.3 cases per 100,000 person-years. Documented substance use among younger stroke patients, mostly involving marijuana, rose from 4.6 percent to 40.2 percent of cases over the same span, alongside increases in high blood pressure, diabetes and atrial fibrillation. Thirty-day mortality after stroke improved slightly, falling from 11.7 percent to 9.4 percent.
Stroke has long been treated clinically as primarily a disease of older age, but this data adds to a body of research suggesting first-time strokes are becoming more common in younger adults nationally. Researchers involved in the study say the rising prevalence of vascular risk factors earlier in life, including obesity, hypertension and diabetes, appears to track with the trend, though the study describes an association rather than a proven cause. Fisher and colleagues have said the findings underscore the importance of identifying and managing stroke risk factors earlier in adulthood, rather than treating stroke prevention as a concern that begins later in life.
What the study can't show
The authors are explicit about a key limitation: because the study tracked only people who had strokes, and not a matched comparison group of stroke-free residents over the same decades, it cannot determine how much of the increase in documented risk factors, such as substance use or hypertension, actually explains the rise in stroke rates rather than simply reflecting better screening and diagnosis over time. The data also come from a single five-county metropolitan region, so the specific rates may not generalize nationally even if the broader upward trend likely does. As a population-based, retrospective analysis, the study can identify a trend but not establish which risk factors are directly causal.
The authors say the next step is research that can better isolate which risk factors are driving the rise, including studies with comparison populations, to help clinicians target prevention efforts at younger patients before a first stroke occurs.