The Worrying Trend Of Rising Stroke Rates In Young People

We often think about stroke as a condition that affects older people, and to some degree, this is true. Strokes affect up to 795,000 people in the US each year and are most commonly seen in those above 65 years old. The average risk of stroke doubles each decade after a person turns 55.¹ ²

However, many people do not realize that this disease, the fourth leading cause of death in the US, can affect people at any age. Stroke in young people has been increasing at a worrying rate in the US and globally, and it can result in significant disability.³ ⁴ ⁵

Hearing about young celebrities having stroke episodes has become more common. For example, model and media personality Hailey Bieber recently shared her experience of having a mini-stroke while eating dinner with her husband. She was only 25 years old at the time.⁶ Actress Emilia Clarke also suffered a life-threatening stroke at the age of 24 after filming Season 1 of the popular television series, Game of Thrones.⁷

The numbers are also in agreement with this anecdotal evidence. About 10%–15% of strokes now affect those between 18 and 45 years of age. Between 2010 to 2016, three times as many counties in the US saw an increase in stroke deaths among middle-aged Americans compared to older people (over 64 years).⁸ ⁹

Despite overall hospitalization rates for ischemic strokes decreasing by 18.4% from 2000 to 2010, an opposite trend was documented for younger age groups. There was a significant rise in rates for patients aged 25 to 44 years (+43.8%) and a slight increase in those aged 45 to 64 years (+4.7%). In contrast, the rates declined for patients aged 65 to 84 years (−28.5%) and those 85 years and over (−22.1%).¹⁰

A shift is clearly happening in the demographics of stroke patients. But the good news is that this shift is largely a result of factors that can be controlled and prevented. Here's what young people need to know about what stroke is, its associated risk factors, and how to react to an episode.

No matter your age, know the signs of stroke

It's crucial to recognize the signs of stroke if it does happen — and this applies to people of any age.

Stroke treatment is highly time-sensitive, and acting fast can significantly lower your chances of disability and death. Every minute that passes after a stroke, 1.9 million brain cells are lost.¹¹

Unfortunately, a recent survey found that almost 30% of young adults (under 45) are unaware of the five most common stroke symptoms. Those of Hispanic ethnicity, people born outside the US, and those with less education were least likely to know the signs of stroke.¹²

To help boost public awareness of this disease, many health institutions recommend using the acronym 'BE FAST' as an easy way to remember the main symptoms of stroke and how to react:

• Balance: Sudden loss of balance or coordination

• Eyes: Sudden loss of vision in one or both eyes; there might also be double vision

• Face: Drooping on one side of the face

• Arms: Sudden arm or leg weakness on one side

• Speech: Problems speaking, slurred speech, or difficulty understanding words

• Time: Call emergency services immediately if you experience any of these symptoms

Most of the time, these stroke signs are the same for both young and older adults. The issue is that some of these symptoms in young adults are often mistaken as something else. For example, dizziness may be diagnosed as a less serious condition like an ear infection. Don't be too quick to brush off seemingly 'slight' symptoms and seek help quickly if you're unsure.¹³

What is a stroke?

A stroke occurs when the arteries that carry blood around your brain become fully or partially blocked or burst. This prevents the blood (and the oxygen it carries) from reaching parts of your brain, which leads to brain cell death.¹⁴

There are two types of stroke:

• Ischemic stroke: Occurs most often when an artery is blocked by a clot. This is commonly the artery leading to the brain. However, it can also occur due to an irregular heartbeat or a blocked artery elsewhere. Approximately 87% of strokes are classified as ischemic strokes.²

• Hemorrhagic stroke: This occurs when a blood vessel in the brain ruptures and causes blood to leak into the brain. This type of stroke is less common.

What are the risk factors for stroke?

Some of the most common risk factors for stroke are linked to lifestyle habits:¹⁵ ¹⁶ ¹⁷ ¹⁸ ¹⁹

• High blood pressure: The high pressure can lead to narrowing or rupturing of the vessels and also increases the risk of clots. This is one of the most prominent causes of stroke.

• High cholesterol: Cholesterol is a fatty deposit in your blood, and having too much of it can lead to it clogging arteries. 

• Heart disease: This encompasses a range of conditions relating to the heart, including atrial fibrillation (irregular heartbeat) and plaque build-up in arteries.

• Diabetes: Over a long period, high blood sugar levels can cause damaged blood vessels.

• Smoking: Increases blood pressure and plaque deposits in your arteries and thickens the blood.

• Obesity: Excess fatty tissue is linked to increased stroke risk.

Approximately half of Americans (49%) have at least one of these three major stroke risk factors — high blood pressure, smoking, and high cholesterol.

In young children and teens, ischemic strokes are the most prevalent and it's usually related to not enough oxygen at birth, genetic disorders, infections like meningitis, and heart defects. Hemorrhagic strokes are more likely to be caused by traumatic brain injury or diseases that affect blood clotting.²⁰

Why are more young people getting strokes?

Strokes in young people have been puzzling researchers as 40%–50% of cases are due to uncertain causes (many have a genetic association).²¹ However, experts suggest that the lifestyle risk factors once associated with older cohorts are now also being seen in younger populations.

According to CDC data, 28% of younger adults between 20 and 39 years old were obese between 2005 to 2006. This number has climbed to 35.7% ten years later.⁸ It's also estimated that hypertension now affects approximately 1 in 8 people between 20 and 40 years of age, and this number is expected to rise.²²

A 2021 study by researchers from Columbia University also found that about 27% (approximately 27 million) of young adults between 18 to 39 years old have low-density lipoprotein (LDL) cholesterol levels that are borderline high or greater.²³ ²⁴

Although there are many overlaps between the stroke risk factors seen across age groups, there are some which are more specific to younger cohorts.

For example, some medications, such as birth control pills, may increase the chance of getting a stroke. The American Stroke Association recommends that women be screened for high blood pressure before being prescribed contraceptive pills. Pregnancy can also increase the risk of stroke because of hormonal and weight changes.¹ ²⁵

Another issue is that young people are more ignorant of their stroke risks compared to older adults because they're not as up-to-date with health checks. A 2019 poll involving 1,200 people in the US indicated that 45% of those between 18 to 29 had no primary care provider. This is compared to 28%, 18%, and 12% for those aged 30–49, 50–64, and 65 and older, respectively. 

Those that don't have a regular doctor are unlikely to be screened for stroke-related risk factors like high blood pressure, high cholesterol, heart disease, and diabetes.²⁶ ²⁷

Barriers to young people receiving regular consultations with a doctor include the perceived high cost of healthcare and the inconvenience of navigating the system.

What's even more worrying is that even when young adults do see the doctor regularly, their risk factors for stroke may not be picked up as readily compared to older individuals. A 2014 study found that the rate of receiving a hypertension diagnosis was 33% slower in people aged 18 to 31 compared to those 60 years and older.²⁸

Females and black adults are at increased risk of stroke at a younger age

Given some of the unique risk factors that affect younger adults, there also seems to be differences in how it affects various sexes and races within this age group compared to the general population.

In the past, men were generally found to be at a greater risk of having strokes than women. A 2009 analysis by researchers found that there was a lower rate of stroke incidence in women compared to men across all age groups except for those 34 and younger.²⁹

However, more recent research published in 2020 explains that this trend is reversing — especially in younger populations. The researchers found more women had strokes compared to men in the 25 to 34 and 35 to 44 age groups. But men still had more strokes than women in the 45 to 74 age group.

Similarly, a Canadian study that followed 9.2 million adults found that the risk of stroke for younger women was higher compared to men of the same age. But as the cohort got older (50–59 years), there was a reversal of gender risk.³⁰

Strokes also seem to be more deadly for women, as 60% of those who die from stroke are female. For some experts, this can be explained by several gender-specific risks, including birth control pills and preeclampsia/eclampsia in pregnancy.³¹

Some unexpected racial trends have also been found in stroke cases amongst younger adults. It has always been well documented that stroke rates are higher in African Americans. They are 50% more likely than white Americans to get a stroke and also have a higher ten-year mortality rate than all other races.³² ³³

However, what has surprised researchers in a recent 2021 study is how the racial disparity is even more pronounced in younger American adults. Researchers monitored 5,000 18- to 30-year-old participants for high blood pressure over 20+ years and found that 100 of them had a stroke over this period. Within this group, it was discovered that Black participants were four times more likely than white peers to experience a stroke. This is significantly higher than the general population.³⁴ ³⁵

It's still unclear why the difference in stroke risk is greater between Black and White young adults compared to older adults. But experts suggest that Black Americans generally face more traditional stroke risk factors (like hypertension and heart disease) along with social stressors. This includes systemic racism in healthcare along with a lack of resources for follow-up care within Black communities.³²

Consequences of stroke in young people

For someone who survives a stroke, the resulting consequences and disabilities can be significantly debilitating.

Some of these longer-term issues can include:³⁶

• Paralysis

• Decline in cognitive function

• Speech and language impairment

• Vision loss

• Eating and swallowing difficulties

• Problems with bladder or bowel control

While strokes at any age are never a good thing, the effects of these complications can impact younger individuals to an even greater degree.

Being at the most productive stage of their lives, younger adults may face more economic strain if the stroke leads to disability and impairs their ability to work. Just the hospitalization cost alone for a young person affected by an ischemic stroke has been estimated to be US$34,886.³⁷ ³⁸

It can also impact other areas of life, including family relationships, mental health, leisure activities, and sex life.³⁹

Reducing your risk of stroke

The silver lining is that you can reduce your risk of stroke. According to the Centers for Disease Control and Prevention (CDC), 80% of strokes could be prevented by changing lifestyle habits and increasing health screenings for known risk factors.⁴⁰

Here are some of the lifestyle recommendations from the CDC to help prevent stroke:⁴¹

• Quit smoking

• Stay active and exercise regularly

• Eat a balanced, healthy diet

• Maintain a healthy weight

• Moderate alcohol consumption

• Go for health screenings and keep health issues like high cholesterol and blood pressure under control

It’s crucial for both the public and healthcare professionals to be more aware of the increased stroke risk in younger people. The faster we act in preventing and treating this condition, the greater the chances of reducing the impact of stroke across all age groups.

The lowdown

Strokes have always been more prevalent in older people. However, the incidence of strokes in younger people is on the rise. What's more, women and Black people are more at risk from strokes in the younger population.

Experts are looking into the reasons for this increase amongst younger people. Initial findings suggest that it is linked to an increase in poor lifestyle choices, including smoking, drinking alcohol, not eating healthily, and not exercising regularly.

Learn to recognize the signs of a stroke and follow the advice on how you can reduce your risk of having one.

Sources:

1. Why are more young people having strokes? | Baton Rouge General

2. Stroke facts | Centers for Disease Control and Prevention

3. Epidemiology, aetiology, and management of ischaemic stroke in young adults (2018)

4. Ischaemic stroke in young adults: a global perspective (2019)

5. Sex differences in stroke: Challenges and opportunities (2018)

6. “It was the scariest moment of my life”: Hailey Bieber opens up about her mini stroke | Vogue

7. Emilia Clarke: ‘I didn’t want people to think of me as sick' | The Guardian

8. Strokes among younger people on the rise | TMC

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14. What is a stroke? | Stroke Foundation

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16. Top causes of stroke | WebMD

17. Diabetes and stroke | Cleveland Clinic

18. Obesity and stroke fact sheet | Obesity Action Coalition

19. High cholesterol | Stroke Association

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21. Stroke in young adults: The lasting effects of trauma | Psychiatric Times

22. Investigation and treatment of high blood pressure in young people: Too much medicine or appropriate risk reduction? (2020)

23. Cost-effectiveness of lipid-lowering treatments in young adults (2021)

24. Statins could benefit millions of young adults with high cholesterol, study suggests | Columbia University Irving Medical Center

25. Pregnancy and stroke: Are you at risk? | Centers for Disease Control and Prevention

26. Spurred By convenience, millennials often spurn the ‘family doctor’ model | KHN

27. Why are more young people having strokes? | Shape

28. Undiagnosed hypertension among young adults with regular primary care use (2014)

29. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes (2009)

30. Stroke incidence by sex across the lifespan (2021)

31. Why are women at higher risk for stroke than men? | The University of Texas Southwestern Medical Center

32. Black Americans have highest long-term death rates from stroke in the nation, study finds | Everyday Health

33. P655 - Race differences in 10-year mortality after ischemic stroke | EventPilot Web

34. Black young adults face higher stroke risk than their white peers | Heart Attack and Stroke Symptoms

35. Blood pressure levels in young adulthood and midlife stroke incidence in a diverse cohort (2021)

36. Effects of stroke | Johns Hopkins Medicine

37. Recognition and management of stroke in young adults and adolescents (2013)

38. Strokes in young adults: epidemiology and prevention (2015)

39. What are the social consequences of stroke for working-aged adults? (2009)

40. CDC grand rounds: Public health strategies to prevent and treat strokes (2017)

41. Prevent stroke: What you can do | Centers for Disease Control and Prevention

Dawn Teh is a health writer and former psychologist who enjoys exploring topics about the mind, body, and understanding what helps humans thrive.