Ischemic Stroke Hospitalizations Rising Among Young People

Allison Gandey

February 25, 2011

February 25, 2011 (Los Angeles, California) — There is a rising risk for stroke among young people, including children and teens, warn analysts from the US Centers for Disease Control and Prevention (CDC).

Presenting new numbers here at the American Stroke Association International Stroke Conference, researchers showed more hospitalizations for acute ischemic stroke among young people age 5 to 44 years at the same time rates were declining among the middle-aged and elderly.

"Acute ischemic stroke is currently considered something that mostly happens to older people," Xin Tong, MPH, a health statistician with the CDC's Division for Heart Disease and Stroke Prevention in Atlanta, Georgia, told reporters attending a news conference. "But awareness of rising rates in the young is important or else tissue plasminogen activator and other important stroke treatment may be unnecessarily delayed in younger patients."

"I think this is a very important use of epidemiological data," Lee Schwamm, MD, director of telestroke and acute stroke services at Massachusetts General Hospital in Boston, told reporters. "These are important findings about the frequency of diagnosis in young and very young patients who have typically been understudied."

Largest Inpatient Database

Using the Nationwide Inpatient Sample, the analysts tracked trends in hospitalizations from 1994 to 2007. This is the largest all-payer inpatient care database in the United States.

Tong showed increasing stroke-related hospitalizations in young patients age 5 to 44 years (P for linear trends < .01).

Increasing Stroke Hospitalizations in Patients Age 5 to 44 Years

Ischemic Stroke Patients Increase (%)
Males age 5 - 14 31
Females age 5 - 14 36
Males age 15 - 34 51
Females age 15 - 34 17
Males age 35 - 44 47
Females age 35 - 44 36

Conversely, they found a decline in stroke hospitalizations for older and younger age groups. The decline in hospitalizations for babies and toddlers exceeded that of middle-aged and elderly patients (P for linear trends < .01).

Decreasing Stroke Hospitalizations by Age Group

Ischemic Stroke Patients Decrease (%)
Males age 0 - 4 31
Females age 0 - 4 51
Males age 45 - 64 12
Females age 45 - 64 13
Males age 65 and older 25
Females age 65 and older 28

"We cannot link anything in particular to the trend in younger patients, but I believe the role of obesity and hypertension will prompt a big discussion," Tong said. "Unfortunately, right now we can't speculate on the causes."

We cannot link anything in particular to the trend in younger patients, but I believe the role of obesity and hypertension will prompt a big discussion.

Dr. Schwamm pointed out the decline in hospitalizations for stroke among older people is consistent with other reports and suggests that this confirms improvements in primary and secondary prevention and controlling traditional risk factors.

"Among children, the story is more complicated," Dr. Schwamm said. "It seems unlikely the increases in hospitalizations are due to traditional risk factors — particularly in patients aged 5 to15. Although in people aged 15 to 35, it also seems unlikely," he noted.

Dr. Schwamm explained that although risk factors such as obesity, hypertension, and diabetes in a child are likely to contribute to cardiovascular disease and atherosclerosis later in life, they probably won't trigger events such as stroke right away.

Better Detection?

Dr. Schwamm suggests the increase in hospitalizations may be related to better detection rather than true incidence or rate of new strokes. He questions whether more widespread use of magnetic resonance imaging is identifying more cases.

"It may also be because it's more cost-effective or leads to greater reimbursement when young adults or children are evaluated in a hospital setting," he said. "This may reflect a shift from outpatient to inpatient care."

Still, he points out, percentage increases can be somewhat misleading. "Hospitalizations for stroke might be very rare but twice as common. Raw rates are different from percentage increases," he said. "The distribution of stroke over decades is important to keep in mind."

In a new study reported by Medscape Medical News investigators showed that diagnosis is often delayed in children. "Stroke in children is rare, but it does exist," lead author Franz Babl, MD, from the Royal Children's Hospital and Murdoch Children's Research Institute in Melbourne, Australia, said in a news release.

The new study was published online February 11 in the Annals of Emergency Medicine.

"Stroke patients in our study had previously been generally healthy, unlike their adult counterparts. Because pediatric stroke is so rare, it's not the first thing we look for," Dr. Babl said. "Stroke symptoms in children are frequently attributed to other, more common problems, such as migraine, seizures, or encephalitis."

This study was funded by the Agency for Healthcare Research and Quality. The researchers have disclosed no relevant financial relationships.

American Stroke Association International Stroke Conference. Abstract #MP70. Presented February 9, 2011.

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