Stroke rates are rising, especially in working-age adults, reversing the gains

SThe prevalence of treke has risen over the past decade, reversing a steady decline among all Americans, while the increase is strongest among adults under 65, a new trend. CDC analysis reports.

Strokes still affect more adults over 65, but the increase at younger ages reflects another recent shift: Heart failure deaths, which had been declining, are rising most among adults under 45.

The rising prevalence comes despite the fact that medications to curb risk factors such as high blood pressure and high cholesterol, as well as technologies to treat strokes, are still unavailable. much more available in richer countries like the US than elsewhere in the world.

Stroke rates in the United States fell by 3.7% over the five-year period ending in 2010, but rose again by 7.8% through 2022. The increase was almost double – 15% – for adults under 65. Mortality Weekly Report has broken this down further to a jump of 14.6% among adults aged 18 to 44 and 15.7% among adults aged 45 to 64.

W. Taylor Kimberly, chief of Neurocritical Care at Mass General Hospital, called the prevalence among younger adults striking. “It is well known that stroke prevalence increases with age, so the fact that it is increasing among younger age groups suggests possible shifts in risk factors, health-related behaviors and possibly awareness,” he said by email. An associate professor of neurology at Harvard Medical School, he was not involved in the CDC investigation.

Stroke is the fifth leading cause of death in the United States and a leading cause of long-term disability. A stroke can happen in two ways: when a blood vessel that carries oxygen and nutrients to the brain is blocked by a clot (ischemic) or by rupture (hemorrhagic). Damage to brain tissue follows dizziness, weakness, numbness, and trouble saying or understanding words.

The report’s authors, from the CDC’s Division of Heart Disease and Stroke Prevention, noted that the increasing prevalence corresponds with an increase in cardiovascular risk factors among younger working-age adults over the past few decades.

They compared two two-year periods: the prevalence of obesity among men increased from 27.5% in 1999 and 2000 to 43% in 2017 and 2018; in women it increased from 33.4% to 41.9%. In 2018, the prevalence of obesity was highest among people aged 40 to 59 years (44.8%). The prevalence of high blood pressure was highest among adults aged 45 to 64 years, from 40.3% in 1999 and 2000 to 46.8% in 2017 and 2018.

There was another factor to consider: opioids. Hospital admissions for strokes related to opioid use and infective endocarditis, a life-threatening infection of the lining and valves of the heart, increased in people under 45 between 2006 and 2015, coinciding with the start of the opioid epidemic, the authors said.

However, the Covid-19 pandemic appears to have made no difference as no significant changes were observed in stroke prevalence before and after the pandemic.

Ethnic and racial differences persisted. Stroke rates were higher among American Indian or Alaska Native, Native Hawaiian or Pacific Islanders, and black adults than white adults. Education was also related to stroke rates: the prevalence among adults with less than a high school diploma was roughly three times higher than among adults with a college degree.

Mass General’s Kimberly linked the increased prevalence among some racial and ethnic groups, as well as among people with different education levels, to less access to health care.

“The report identifies the need to raise awareness not only of stroke and stroke symptoms, but also of the health conditions that can increase the risk of stroke,” he said. “Prevention or early intervention for these health conditions (hypertension, diabetes) is an important public health strategy to reduce the impact of stroke.”

The MMWR report is based on responses to a Behavioral Risk Factor Surveillance System survey question: “Has a doctor or other health care provider ever told you that you have had a stroke?” The authors acknowledge the limitations of self-reported data.

As with rising deaths from heart failure, it is possible that as people live longer, more and more people will develop serious cardiovascular problems. In the case of strokes, it is possible for people to survive a first stroke due to greater awareness of the stroke Warning signsand then live to get another.

Across racial and ethnic groups, increasing numbers of people are receiving treatments to break down the blood clots that can cause ischemic strokes, from 10% to 15% from 2003 to 2009, to 43% to 46% in 2021. Still, disparities persisted . Asian, black, and Hispanic patients were less likely than white patients to go to the hospital within 4.5 hours of the onset of ischemic stroke and also less likely to receive these treatments.

“Better recognition of the signs and symptoms of stroke may have contributed to increased stroke prevalence, as earlier stroke treatment contributes to better outcomes,” the authors wrote. “Initiatives to promote knowledge of the signs and symptoms of stroke, and the identification of disparities in stroke prevalence, can help effectively target interventions to improve stroke prevention and treatment.

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