Deaths from stroke in US young adults, 1989-2009

Sharon N Poisson; David Glidden; S Claiborne Johnston; Heather J Fullerton

doi:10.1212/WNL.0000000000001042

Deaths from stroke in US young adults, 1989-2009

Neurology. 2014 Dec 2;83(23):2110-5. doi: 10.1212/WNL.0000000000001042. Epub 2014 Oct 31.

Authors

Sharon N Poisson¹, David Glidden², S Claiborne Johnston², Heather J Fullerton²

Affiliations

¹ From the Department of Neurology (S.N.P.), University of Colorado Denver, Aurora; the Departments of Epidemiology and Biostatistics (D.G.) and Neurology and Pediatrics (H.J.F.), University of California San Francisco; and Dell Medical School (S.C.J.), University of Texas, Austin. Sharon.Poisson@ucdenver.org.
² From the Department of Neurology (S.N.P.), University of Colorado Denver, Aurora; the Departments of Epidemiology and Biostatistics (D.G.) and Neurology and Pediatrics (H.J.F.), University of California San Francisco; and Dell Medical School (S.C.J.), University of Texas, Austin.

Abstract

Objective: To determine what the trends in stroke mortality have been over 2 decades in young adults.

Methods: In this cohort study, we analyzed death certificate data for ischemic and hemorrhagic stroke (intracerebral hemorrhage [ICH] and subarachnoid hemorrhage [SAH]) in adults aged 20-44 in the United States for 1989 through 2009, covering approximately 2.2 billion person-years. Poisson regression was used to calculate and compare time trend data between groups and to compare trends in young adults to those in adults over age 45.

Results: Mortality from stroke in young adults declined by 35% over the study period, with reductions in all 3 stroke subtypes (ischemic stroke decreased by 15%, ICH by 47%, and SAH by 50%). Black race was a risk factor for all 3 stroke subtypes (relative risk 2.4 for ischemic stroke, 4.0 for ICH, and 2.1 for SAH), but declines in all stroke subtypes were more dramatic in black compared to white participants (p < 0.001 for all stroke subtypes).

Conclusions: Although hospitalizations for stroke in young patients have been increasing, the apparent decrease in mortality rates and in racial disparities suggests that recognition and treatment in this group may be improving.

MeSH terms

Adolescent
Adult
Black or African American
Brain Ischemia / mortality*
Cerebral Hemorrhage / mortality*
Cohort Studies
Female
Humans
Intracranial Hemorrhages / mortality*
Male
Risk Factors
Stroke / mortality*
United States
White People