1. Stroke in Young Adults
Ekta Chaudhary, Dr. Amelia Boehme
Site: Columbia University Irving Medical Centre, Department of Neurology
Every four minutes, a person in the US dies of stroke. Stroke is the fifth leading
cause of death in the US, affecting more than 795,000 people per year. While
the risk of stroke increases with age, approximately 1 in 3 patients hospitalized
for stroke are less than 65 years of age. Stroke in young adults accounts for
approximately 10% to 12% of total stroke patients. Stroke may have devastating
consequences when they occur in the first decades of life, by leaving patients
disabled in the most crucial years of their life. Recent publications report an
increased incidence of stroke in young adults. The number of Ischemic Stroke
and Sub-Arachnoid cases has markedly increased over time. This is significant
given the fact that younger stroke patients have an increased risk of death
compared with the general population. Modifiable risk factors for stroke, such
as Diabetes Mellitus, Smoking, Chronic Renal disease and Hypertension, are
highly prevalent in the young stroke population. Prevention is the primary
strategy aimed at reducing morbidity and mortality related to stroke. Therefore,
primary prevention is very important with regard to stroke in young adults, and
treatment of risk factors for stroke, such as Diabetes Mellitus, Hypertension,
Smoking, Migraine, and Chronic Renal disease is essential.
Data for the analysis comes from the State-wide Planning and Research
Cooperative System (SPARCS) 2004-2015. Data was collected on age, sex, race
and ethnicity. For the analysis, age was stratified into two categories: Age_Cat 1
including individuals aged 18-60 years and Age_Cat 0 including individuals aged
> 60 years. The number of Ischemic stroke and Sub arachnoid cases was
determined by age category, sex, race and ethnicity. Statistical analysis used
logistic regression with odds ratios (OR) and 95% CI to determine the association
between Ischemic Stroke, Sub arachnoid haemorrhage and the risk factors i.e.
Diabetes Mellitus, Chronic Renal disease, Pre-existing Hypertension, and
Smoking.
Racial and ethnic differences in the risk of Ischemic Stroke and Subarachnoid
Haemorrhage are well recognized (Figure 1). The SPARCS 2004-2015 data
analysis showed that young African Americans have a greater prevalence of
Ischemic Stroke and Subarachnoid Haemorrhage as compared to other racial
groups. The prevalence of Ischemic stroke and Subarachnoid Haemorrhage in
the young has been reported to be higher for women than for men. People of
Spanish/ Hispanic origin have a lesser prevalence of Ischemic Stroke and
Subarachnoid Haemorrhage as compared to people of other ethnicity.
METHODS
From 2004-2015, the prevalence of Subarachnoid Haemorrhage has been
higher among young adults whereas, the prevalence of Ischemic stroke has
been higher among older individuals. Overall, the prevalence of both Ischemic
stroke and Subarachnoid Haemorrhage has increased over time (Figure 2).
A strong association was seen between Ischemic stroke and Diabetes,
Hypertension, and Smoking. Subarachnoid Haemorrhage was found to be
only associated with Hypertension.
Conducted literature review, Acquired data set, wrote SAS code and
conducted statistical analyses using Logistic Regression, Produced
tables/figures of analysis.
Figure 1: Prevalence of Ischemic Stroke and Sub-Arachnoid hemorrhage
by Race And Gender
Stroke Facts. (n.d.). Retrieved from https://www.cdc.gov/stroke/facts.htm
Wilner, A. N. (2018, December 24). Stroke in Young Patients: 5 New Things.
Retrieved from https://www.neurologytimes.com/stroke/stroke-young-
patients-5-new-things
75
202
176
133 152
173
179
519
600
604
808
632
38
87
69 71 66 83 89
217
296
276
355
325
0
100
200
300
400
500
600
700
800
900
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Subarachnoid hemorrhage
(Age_cat = 1)
Subarachnoid hemorrhage
(Age_cat = 0)
Figure 2:Number of Ischemic Stroke and Sub-Arachnoid cases from
2004-2015 by Age Category. Age_Cat 1:18 to 60 years, Age_Cat 0: >60 years
CONCLUSION
STUDENT CONTRIBUTION REFERENCES
RESULTSBACKGROUND
200 268 305 323
282 391 551
9038
9990
8446
9471
8136
241
438
460
469 587
900
969
11645
12507
12131
12956
10234
0
2000
4000
6000
8000
10000
12000
14000
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Ischemic stroke
(Age_cat = 1)
Ischemic stroke
(Age_cat = 0)
35.16 37.87
42.23
31.77
18.2
22.11
3.8
7.18
0
10
20
30
40
50
60
70
80
90
100
Ischemic stroke Subarachnoid hemorrhage
Native Americans
Asians
Whites
African-Americans
Others
An adequate treatment, control of risk factors, and lifestyle changes can prevent
up to 50% of strokes. In the near future, organizations such as the World Stroke
Organization, the American Heart and Stroke Association should make an effort
to publish recommendations or guidelines for the prevention and treatment of
stroke in young adults.
Males
46.33%
Females
53.67%
Males
46.33%