Stroke rates nearly doubled among adults 20 to 54 in Cincinnati region since 1990s

by American Academy of Neurology

edited by Sadie Harley, reviewed by Andrew Zinin

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Stroke is becoming more common among younger adults, according to a study published in Neurology. Researchers found that strokes among adults ages 20 to 54 nearly doubled over nearly three decades, even as short-term survival after stroke improved.

"While stroke has traditionally been considered a disease of older adults, our findings show that stroke is becoming increasingly common in younger adults," said study author Emily R. Fisher, M.D., of the University of Cincinnati. "At the same time, more people are surviving these strokes, which means more younger adults may be living with the long-term effects of stroke."

The study examined strokes in the Greater Cincinnati and Northern Kentucky region from 1993 through 2020. Researchers identified 2,076 first-ever strokes among adults ages 20 to 54.

Researchers found that the rate of strokes among younger adults increased from 33.9 cases per 100,000 person-years in 1993–94 to 62.2 cases per 100,000 person-years in 2020.

The increase appeared to be driven by ischemic stroke, which occurs when blood flow to part of the brain is blocked. The ischemic stroke rate rose from 23.8 cases per 100,000 person-years in 1993–94 to 47.3 cases per 100,000 person-years in 2020.

Researchers did not find similar increases for other types of stroke, such as intracerebral hemorrhage, a bleeding stroke within the brain, or subarachnoid hemorrhage, a bleeding stroke around the brain.

Researchers found that some health problems became more common over time among people who had a stroke. There were increases in high blood pressure, diabetes, atrial fibrillation and substance use among younger adults who had a stroke. Substance use among younger adults with stroke increased from 4.6% in 1993–94 to 40.2% in 2020, with much of the increase reflecting marijuana use.

Researchers also looked at 30-day death rates after stroke. After adjusting for age, race and sex, researchers found a slight decline over time, from 11.7% in 1993–94 to 9.4% in 2020. Improvements were largely seen among people with intracerebral hemorrhage and subarachnoid hemorrhage.

"Our findings highlight the importance of identifying and managing stroke risk factors early in adulthood," Fisher said. "Additional research is needed to better understand what is driving these trends and how they can be reversed."

A limitation of the study was that researchers did not have comparable information from people without stroke, so they could not determine whether observed trends in risk factors explain the increase in stroke rates.

Publication details

Neurology (2026)

Journal information: Neurology

Key medical concepts

StrokeIschemic StrokeSubstance Uses

Clinical categories

NeurologyCommon illnesses & PreventionPreventive medicine Provided by American Academy of Neurology Who's behind this story?

Sadie Harley

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