In the Journals

Younger adults experiencing more ischemic strokes, CV risk factors

Even with the decrease of stroke mortality rates in older adults, hospitalization rates for ischemic stroke and traditional stroke risk factors are on the rise in young adults, according to a study in JAMA Neurology.

Researchers analyzed data of patients aged 18 to 64 years from the National Inpatient Sample from 1995 to 2012. Age groups were defined as the following: 18 to 34 years, 35 to 44 years, 45 to 54 years and 55 to 64 years. The combination of CV risk factors, including diabetes, hypertension, obesity, lipid disorders and tobacco use, were reviewed from hospitalization data from 2003 to 2012.

Stroke hospitalizations rose

Rates of acute ischemic stroke hospitalizations increased from 2003 to 2012 for all race and ethnic groups, all age groups for men and most age groups except 55 to 64 years for women. A significant increase in hospitalizations for acute ischemic stroke was noted in Hispanic patients aged 55 to 64 years (181.8 per 10,000 hospitalizations to 199.7 per 10,000 hospitalizations; P = .02).

Hospitalizations increased for men aged 18 to 34 years (74.8%), women aged 18 to 34 years (65.7%), men aged 35 to 44 years (91%) and women aged 35 to 44 (53.6%).

Risk factors in patients admitted for acute ischemic stroke increased across all sexes and age groups. The incidence of patients with three or more risk factors nearly doubled in all groups during the study period (P for trend < .001). From 2003 to 2012, the occurrence of lipid disorders increased in men aged 18 to 34 years from 14.6% to 29.1%. Within the same group, hypertension increased from 34% to 41.3%. In women aged 18 to 34 years, minor increases were seen within that period except from 2011 to 2012, when 30.7% had hypertension, 26.5% used tobacco, 21.7% had lipid disorders and 15.7% were obese. Three to five risk factors were seen in 33% of men aged 35 to 44 years and 14% of men aged 18 to 34 years.
Hospitalization rates for intracerebral hemorrhage did not change from 2003 to 2012 in any age groups, race or sex.

“Preventing and controlling stroke risk factors among young working-age adults can save lives, reduce disability, decrease societal health care costs and improve the quality of life for hundreds of thousands of Americans and their families,” Mary G. George, MD, MSPH, deputy associate director for science and senior medical officer in the division for heart disease and stroke prevention at the CDC, and colleagues wrote. “Identifying the high and rising prevalence of stroke risk factors should prompt a sense of urgency among younger adults, public health practitioners, clinicians and policymakers to engage adolescents and their families, as well as younger adults, to identify and treat stroke risk factors and promote opportunities that allow for healthy lifestyles to prevent the tragedy of stroke at such early ages.”

Coding may be factor

In a related editorial, James F. Burke, MD, MS, and Lesli E. Skolarus, MD, MS, assistant professors of neurology at the University of Michigan in Ann Arbor, wrote: “The authors found an increase in vascular risk factor prevalence over time, which seems to suggest that the trend is a true epidemiologic phenomenon. However, it is also possible that the increase in risk factors over time reflects more accurate coding as part of a general trend toward increasingly accurate coding practices over time or changes in the definitions of risk factors. Thus, just as apparent stroke hospitalization rates may change with changes in the coding system, so too may apparent risk factor prevalence.” – by Darlene Dobkowski

Disclosure: The researchers report no relevant financial disclosures.

Even with the decrease of stroke mortality rates in older adults, hospitalization rates for ischemic stroke and traditional stroke risk factors are on the rise in young adults, according to a study in JAMA Neurology.

Researchers analyzed data of patients aged 18 to 64 years from the National Inpatient Sample from 1995 to 2012. Age groups were defined as the following: 18 to 34 years, 35 to 44 years, 45 to 54 years and 55 to 64 years. The combination of CV risk factors, including diabetes, hypertension, obesity, lipid disorders and tobacco use, were reviewed from hospitalization data from 2003 to 2012.

Stroke hospitalizations rose

Rates of acute ischemic stroke hospitalizations increased from 2003 to 2012 for all race and ethnic groups, all age groups for men and most age groups except 55 to 64 years for women. A significant increase in hospitalizations for acute ischemic stroke was noted in Hispanic patients aged 55 to 64 years (181.8 per 10,000 hospitalizations to 199.7 per 10,000 hospitalizations; P = .02).

Hospitalizations increased for men aged 18 to 34 years (74.8%), women aged 18 to 34 years (65.7%), men aged 35 to 44 years (91%) and women aged 35 to 44 (53.6%).

Risk factors in patients admitted for acute ischemic stroke increased across all sexes and age groups. The incidence of patients with three or more risk factors nearly doubled in all groups during the study period (P for trend < .001). From 2003 to 2012, the occurrence of lipid disorders increased in men aged 18 to 34 years from 14.6% to 29.1%. Within the same group, hypertension increased from 34% to 41.3%. In women aged 18 to 34 years, minor increases were seen within that period except from 2011 to 2012, when 30.7% had hypertension, 26.5% used tobacco, 21.7% had lipid disorders and 15.7% were obese. Three to five risk factors were seen in 33% of men aged 35 to 44 years and 14% of men aged 18 to 34 years.
Hospitalization rates for intracerebral hemorrhage did not change from 2003 to 2012 in any age groups, race or sex.

“Preventing and controlling stroke risk factors among young working-age adults can save lives, reduce disability, decrease societal health care costs and improve the quality of life for hundreds of thousands of Americans and their families,” Mary G. George, MD, MSPH, deputy associate director for science and senior medical officer in the division for heart disease and stroke prevention at the CDC, and colleagues wrote. “Identifying the high and rising prevalence of stroke risk factors should prompt a sense of urgency among younger adults, public health practitioners, clinicians and policymakers to engage adolescents and their families, as well as younger adults, to identify and treat stroke risk factors and promote opportunities that allow for healthy lifestyles to prevent the tragedy of stroke at such early ages.”

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Coding may be factor

In a related editorial, James F. Burke, MD, MS, and Lesli E. Skolarus, MD, MS, assistant professors of neurology at the University of Michigan in Ann Arbor, wrote: “The authors found an increase in vascular risk factor prevalence over time, which seems to suggest that the trend is a true epidemiologic phenomenon. However, it is also possible that the increase in risk factors over time reflects more accurate coding as part of a general trend toward increasingly accurate coding practices over time or changes in the definitions of risk factors. Thus, just as apparent stroke hospitalization rates may change with changes in the coding system, so too may apparent risk factor prevalence.” – by Darlene Dobkowski

Disclosure: The researchers report no relevant financial disclosures.