Skip to main content
AAN.com
Article
April 24, 2019

Stroke incidence in young adults according to age, subtype, sex, and time trends

May 21, 2019 issue
92 (21) e2444-e2454

Abstract

Objective

To investigate incidence of stroke and its subtypes in young adults, according to sex and age, and to study trends over time.

Methods

We established a nationwide cohort through linkage of national registries (hospital discharge, cause of death, and population register) with patients aged 18–50 years and those ≥50 years with first-ever ischemic stroke, intracerebral hemorrhage, or unspecified stroke, using ICD-9/ICD-10 codes between 1998 and 2010 in the Netherlands. Outcomes were yearly incidence of stroke stratified by age, sex, and stroke subtype, its changes over time, and comparison of incidence in patients 18–50 years to patients ≥50 years.

Results

We identified 15,257 patients (53% women; mean age 41.8 years). Incidence increased exponentially with age (R2 = 0.99) and was higher for women than men, most prominently in the youngest patients (18–44 years). The relative proportion of ischemic stroke increased with age (18–24 years: 38.3%; 44–49 years: 56.5%), whereas the relative proportion of intracerebral hemorrhage decreased (18–24 years: 34.0%; 44–49 years: 18.3%). Incidence of any stroke in young adults increased (1998: 14.0/100,000 person-years: 2010: 17.2; +23%; p < 0.001), driven by an increase in those aged over 35 years and ischemic stroke incidence (46%), whereas incidence decreased in those ≥50 years (329.1%–292.2%; −11%; p = 0.009).

Conclusions

Incidence of any stroke in the young increases with age in patients over 35, is higher in women than men aged 18–44 years, and has increased by 23% in one decade, through an increase in ischemic stroke. Incidence of intracerebral hemorrhage is comparable for women and men and remained stable over time.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Kissela B, Khoury J, Alwell K, et al. Age at stroke: temporal trends in stroke incidence in a large, biracial population. Neurology 2012;79:1781–1787.
2.
Singhal AB, Biller J, Elkind MS, et al. Recognition and management of stroke in young adults and adolescents. Neurology 2013;81:1089–1097.
3.
World Health Organization. Stroke, Cerebrovascular Accident. 2017. Available at: emro.who.int/health-topics/stroke-cerebrovascular-accident/index.html. Accessed October 20, 2017.
4.
Bejot Y, Bailly H, Durier J, Giroud M. Epidemiology of stroke in Europe and trends for the 21st century. Presse Med 2016;45:391–398.
5.
Sultan S, Elkind MS. The growing problem of stroke among young adults. Curr Cardiol Rep 2013;15:421.
6.
Tibaek M, Dehlendorff C, Jorgensen HS, Forchhammer HB, Johnsen SP, Kammersgaard LP. Increasing incidence of hospitalization for stroke and transient ischemic attack in young adults: a registry-based study. J Am Heart Assoc 2016;5:e003158.
7.
George MG, Tong X, Kuklina EV, Labarthe DR. Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995-2008. Ann Neurol 2011;70:713–721.
8.
Putaala J, Metso AJ, Metso TM, et al. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki Young Stroke Registry. Stroke 2009;40:1195–1203.
9.
Jacobs BS, Boden-Albala B, Lin IF, Sacco RL. Stroke in the young in the Northern Manhattan Stroke Study. Stroke 2002;33:2789–2793.
10.
Bejot Y, Daubail B, Jacquin A, et al. Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: the Dijon Stroke Registry. J Neurol Neurosurg Psychiatry 2014;85:509–513.
11.
Medin J, Nordlund A, Ekberg K. Increasing stroke incidence in Sweden between 1989 and 2000 among persons aged 30 to 65 years: evidence from the Swedish Hospital Discharge Register. Stroke 2004;35:1047–1051.
12.
Diaz-Guzman J, Egido JA, Gabriel-Sanchez R, et al. Stroke and transient ischemic attack incidence rate in Spain: the IBERICTUS study. Cerebrovasc Dis 2012;34:272–281.
13.
Jolink WMT, Klijn CJM, Brouwers PJAM, et al. Time trends in incidence, case fatality, and mortality of intracerebral hemorrhage. Neurology 2015;85:1318–1324.
14.
Tirschwell DL, Longstreth WT. Validating administrative data in stroke research. Stroke 2002;33:2465–2470.
15.
Fernandes PM, Whiteley WN, Hart SR, Al-Shahi Salman R. Strokes: mimics and chameleons. Pract Neurol 2013;13:21–28.
16.
Vaartjes I, Reitsma JB, de Bruin A, et al. Nationwide incidence of first stroke and TIA in the Netherlands. Eur J Neurol 2008;15:1315–1323.
17.
Nieuwkamp DJ, Vaartjes I, Algra A, Bots ML, Rinkel GJ. Age- and gender-specific time trend in risk of death of patients admitted with aneurysmal subarachnoid hemorrhage in the Netherlands. Int J Stroke 2013;8(suppl A100):90–94.
18.
Vaartjes I, O'Flaherty M, Capewell S, Kappelle J, Bots M. Remarkable decline in ischemic stroke mortality is not matched by changes in incidence. Stroke 2013;44:591–597.
19.
Bevolking; generatie, geslacht, leeftijd en herkomstgroepering, 1 Januari. CBS Statline. 2017. Available at: statline.cbs.nl/Statweb/publication/?DM=SLNL&PA=37325&D1=0&D2=a&D3=0&D4=a&D5=0&D6=18-21&VW=T. Accessed January 16, 2017.
20.
Bejot Y, Delpont B, Giroud M. Rising stroke incidence in young adults: more epidemiological evidence, more questions to be answered. J Am Heart Assoc 2016;5:e003661.
21.
Cabral NL, Freire AT, Conforto AB, et al. Increase of stroke incidence in young adults in a middle-income country: a 10-year population-based study. Stroke 2017;48:2925–2930.
22.
Sipilä JOT, Posti JP, Ruuskanen JO, Rautava P, Kytö V. Stroke hospitalization trends of the working-aged in Finland. PLoS One 2018;13:e0201633.
23.
George MG, Tong X, Bowman BA. Prevalence of cardiovascular risk factors and strokes in younger adults. JAMA Neurol 2017;74:695–703.
24.
Maaijwee NA, Rutten-Jacobs LC, Schaapsmeerders P, van Dijk EJ, de Leeuw FE. Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol 2014;10:315–325.
25.
Putaala J, Curtze S, Hiltunen S, Tolppanen H, Kaste M, Tatlisumak T. Causes of death and predictors of 5-year mortality in young adults after first-ever ischemic stroke: the Helsinki Young Stroke Registry. Stroke 2009;40:2698–2703.
26.
Feigin VL, Roth GA, Naghavi M, et al. Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol 2016;15:913–924.
27.
de los Rios F, Kleindorfer DO, Khoury J, et al. Trends in substance abuse preceding stroke among young adults: a population-based study. Stroke 2012;43:3179–3183.
28.
Van Rooij AJ, Schoenmakers TM, Van de Mheen D. Nationaal Prevalentie Onderzoek Middelengebruik 2009: kerncijfers 2009. Rotterdam: IVO; 2011.
29.
Abraham M, Cohen P, Van Til RJ, De Winter M. Licit and Illicit Drug Use in the Netherlands. Amsterdam: UvA/CBS, CEDRO; 1999.
30.
Gokhale S, Caplan LR, James ML. Sex differences in incidence, pathophysiology, and outcome of primary intracerebral hemorrhage. Stroke 2015;46:886–892.
31.
Giroud M, Delpont B, Daubail B, et al. Temporal trends in sex differences with regard to stroke incidence: the Dijon Stroke Registry (1987-2012). Stroke 2017;48:846–849.
32.
Ekker MS, Boot EM, Singhal AB, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol 2018;17:790–801.
33.
Adams HP, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial: TOAST: Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35–41.
34.
Chau PH, Woo J, Goggins WB, et al. Trends in stroke incidence in Hong Kong differ by stroke subtype. Cerebrovasc Dis 2011;31:138–146.
35.
Putaala J, Haapaniemi E, Metso AJ, et al. Recurrent ischemic events in young adults after first-ever ischemic stroke. Ann Neurol 2010;68:661–671.
36.
Boehme AK, Kumar AD, Dorsey AM, et al. Infections present on admission compared with hospital-acquired infections in acute ischemic stroke patients. J Stroke Cerebrovasc Dis 2013;22:582–589.

Information & Authors

Information

Published In

Neurology®
Volume 92Number 21May 21, 2019
Pages: e2444-e2454
PubMed: 31019103

Publication History

Received: October 5, 2018
Accepted: January 22, 2019
Published online: April 24, 2019
Published in issue: May 21, 2019

Permissions

Request permissions for this article.

Disclosure

M. Ekker and J. Verhoeven report no disclosures relevant to the manuscript. I. Vaartjes is funded by the Dutch Heart Foundation for project Facts and Figures. The Julius Center and the Dutch Heart Foundation had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. K. Nieuwenhuizen reports no disclosures relevant to the manuscript. C. Klijn is supported by a clinical established investigator grant from the Dutch Heart Foundation (2012T077) and by an ASPASIA grant from The Netherlands Organisation for Health Research and Development, ZonMw (grant number 015008048). F. de Leeuw is supported by a clinical established investigator grant from the Dutch Heart Foundation (2014 T060) and by a VIDI innovational grant from The Netherlands ZonMw (grant number 016126351). Go to Neurology.org/N for full disclosures.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

From the Department of Neurology (M.S.E., J.I.V., C.J.M.K., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; and Julius Center for Health Sciences and Primary Care (I.V.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (K.M.v.N., C.J.M.K.), University Medical Center Utrecht, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Jamie I. Verhoeven, BSc*
From the Department of Neurology (M.S.E., J.I.V., C.J.M.K., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; and Julius Center for Health Sciences and Primary Care (I.V.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (K.M.v.N., C.J.M.K.), University Medical Center Utrecht, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Ilonca Vaartjes, PhD
From the Department of Neurology (M.S.E., J.I.V., C.J.M.K., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; and Julius Center for Health Sciences and Primary Care (I.V.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (K.M.v.N., C.J.M.K.), University Medical Center Utrecht, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
European Journal of Preventive Cardiology, deputy editor, 2014, 2015, 2016, 2017
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Dutch Heart Foundation grant Facts and Figures
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Koen M. van Nieuwenhuizen, MD
From the Department of Neurology (M.S.E., J.I.V., C.J.M.K., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; and Julius Center for Health Sciences and Primary Care (I.V.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (K.M.v.N., C.J.M.K.), University Medical Center Utrecht, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Catharina J.M. Klijn, MD, PhD
From the Department of Neurology (M.S.E., J.I.V., C.J.M.K., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; and Julius Center for Health Sciences and Primary Care (I.V.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (K.M.v.N., C.J.M.K.), University Medical Center Utrecht, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Have been giving a lecture during a teaching course supported by Boehringer Ingelheim, received payment for hours spent (2014). Topic not related to the current study. Have given lecture for a scientific presentation supported by Boehringer (2015), received payment for hours spent. Topic not related to the current study. Have given lecture for a scientific presentation supported by Penumbra (2016), received payment for hours spent. Topic not related to the current study.
Editorial Boards:
1.
Associate editor for European Stroke Journal.
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
CJMK is supported by a clinical established investigator grant of the Dutch Heart Foundation (No 2012T077), and an Aspasia grant from the Netherlands Organisation for Health Research and Development, ZonMw (015008048).
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Frank-Erik de Leeuw, MD, PhD
From the Department of Neurology (M.S.E., J.I.V., C.J.M.K., F.-E.d.L.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen; and Julius Center for Health Sciences and Primary Care (I.V.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (K.M.v.N., C.J.M.K.), University Medical Center Utrecht, the Netherlands.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
VIDI innovational grant from The Netherlands Organisation for Health Research and Development (ZonMw grant 016?126?351)
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
supported by a clinical established investigator grant of the Dutch Heart Foundation (grant number 2014 T060)
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. de Leeuw [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
*
These authors contributed equally to this work as co–first authors.
These authors contributed equally to this work as co–last authors.

Metrics & Citations

Metrics

Citation information is sourced from Crossref Cited-by service.

Citations

Download Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.

Cited By
  1. Mortalidad y recurrencia a largo plazo del ictus isquémico en adultos jóvenes en Aragón, Neurología, 40, 4, (333-343), (2025).https://doi.org/10.1016/j.nrl.2023.02.005
    Crossref
  2. JCS/JCC/JACR/JATS 2024 Guideline on Cardiovascular Practice With Consideration for Diversity, Equity, and Inclusion, Circulation Journal, 89, 5, (658-739), (2025).https://doi.org/10.1253/circj.CJ-23-0890
    Crossref
  3. Racial and Ethnic Differences in Advance Care Planning and End-of-Life Care in Older Adults With Stroke, Neurology, 104, 8, (2025)./doi/10.1212/WNL.0000000000213486
    Abstract
  4. Endovascular thrombectomy in young patients with large vessel occlusion stroke: a systematic review and meta-analysis, Neurosurgical Review, 48, 1, (2025).https://doi.org/10.1007/s10143-025-03499-w
    Crossref
  5. Lifestyle risk factors and stroke: findings from the national health and nutrition examination survey (1999–2020) and a Mendelian randomization analysis, Neurological Research, (1-12), (2025).https://doi.org/10.1080/01616412.2025.2490959
    Crossref
  6. Menopause-related changes in vascular signaling by sex hormones, The Journal of Pharmacology and Experimental Therapeutics, 392, 4, (103526), (2025).https://doi.org/10.1016/j.jpet.2025.103526
    Crossref
  7. Temporal Trends in Vascular Risk Factor Burden Among Young Adults With Ischemic Stroke, Neurology, 104, 6, (2025)./doi/10.1212/WNL.0000000000213447
    Abstract
  8. The Efficacy of Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy on Cognitive Impairment in Post-Stroke Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, Mindfulness, (2025).https://doi.org/10.1007/s12671-025-02557-0
    Crossref
  9. Ischaemic stroke in young adults: an overview of the classification, risk factors, aetiologies and outcomes, Singapore Medical Journal, (2025).https://doi.org/10.4103/singaporemedj.SMJ-2024-010
    Crossref
  10. Cognitive performance is associated with return to work after ischemic stroke in young adults: The ODYSSEY study, European Stroke Journal, (2025).https://doi.org/10.1177/23969873251324400
    Crossref
  11. See more
Loading...

View Options

Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Personal login Institutional Login
Purchase Options

The neurology.org payment platform is currently offline. Our technical team is working as quickly as possible to restore service.

If you need immediate support or to place an order, please call or email customer service:

  • 1-800-638-3030 for U.S. customers - 8:30 - 7 pm ET (M-F)
  • 1-301-223-2300 for customers outside the U.S. - 8:30 - 7 pm ET (M-F)
  • [email protected]

We appreciate your patience during this time and apologize for any inconvenience.

View options

PDF and All Supplements

Download PDF and Supplementary Material

Short Form

Short Form

Full Text

View Full Text

Full Text HTML

View Full Text HTML

Figures

Tables

Media

Share

Share

Share article link

Share