Home | Contact us
Stroke in the Young image

​​​​​​Q & A: Stroke in the Young

Why study stroke in the young?​​

Stroke is the leading cause of disability and the fourth leading cause of death in the United States. Most strokes occur in older adults, but there has been increasing recognition over the past decade of the importance of stroke as a cause of disability and productive years lost in children and young adults. Historical impressions that children recover well from stroke have been contradicted by recent outcome studies that document a high rate of life-long disability. As a major contributor to health care costs, stroke is also a public health concern. The lifetime cost of a stroke in a young adult is estimated at more than $500,000, and the 5-year direct cost of an ischemic stroke in a child is about $130,000. In addition, the total number of years that young stroke patients will live with the consequences of the stroke exceeds that of older stroke survivors due to far longer survival.

What are the incidence rates of stroke in the young?​​

The current rate of ischemic stroke in U.S. children is at least 2.4 per 100,000 person-years, which is two to four times higher than previously published rates. In young adults, incidence rates for ischemic stroke range from 6.6 to 11.4 per 100,000 person-years (the definition of "young adult" varied in these different studies).

Recent studies report declining overall rates of stroke hospitalizations over the last 10 years. In studies that stratify rates by age range, this decline is accounted for by trends in older adults (age 50 and older). Fewer studies have characterized the trends in stroke in young adults, but most suggest a trend toward increasing rates over the last two decades.

What are the causes of stroke and atherosclerotic risk factors for stroke in the young?

Childhood ischemic stroke has been linked with a variety of chronic conditions, such as congenital heart disease, hematological disorders such as sickle cell disease, autoimmune diseases such as systemic lupus erythematosus, and diseases of the arteries. There is emerging evidence that head and neck trauma can be an important risk factor in childhood stroke, as it is in young adults. The most common stroke factors in young adults are cardioembolism and cervicocerebral artery dissection. Reports of migraine with aura as a risk factor in young adults are variable, but it does appear to increase risk.

Although atherosclerotic risk factors have historically not been considered major factors in stroke among children and young adults, older atherosclerosis literature actually indicates that this disease can begin in childhood. Data from both autopsy and carotid ultrasound studies suggest that atherosclerosis develops early in life and is related to the number of typical risk factors present. Recent studies have suggested that atherosclerotic risk factors are common in young adults who have had strokes, and may be increasing over time. A large study utilizing the National Inpatient Sample found that hypertension, diabetes, obesity, lipid disorders, and tobacco use were among the most common conditions coexisting with stroke in children and young adults, and that the prevalence of these cardiovascular risk factors had increased over a decade.

What are the causes of stroke and atherosclerotic risk factors for stroke in the young?

Childhood ischemic stroke has been linked with a variety of chronic conditions, such as congenital heart disease, hematological disorders such as sickle cell disease, autoimmune diseases such as systemic lupus erythematosus, and diseases of the arteries. There is emerging evidence that head and neck trauma can be an important risk factor in childhood stroke, as it is in young adults. The most common stroke factors in young adults are cardioembolism and cervicocerebral artery dissection. Reports of migraine with aura as a risk factor in young adults are variable, but it does appear to increase risk.

What are the ethnic disparities in stroke?

Extensive evidence suggests differences in the burden of stroke and atherosclerotic risk factors among racial and ethnic minorities in the United States. In addition, strokes occur at younger ages in minority groups, and are associated with higher mortality. Large population-based studies have found a rate ratio of stroke in blacks compared with non-Hispanic whites between 1.4 and 2.7 in adults over 55 years, and between 3.8 and 9 in adults aged 25 to 55 years. Among children, rates of stroke have also been found to be higher in African-Americans compared to non-Hispanic whites. Rates among Mexican Americans and Hispanics are 1.2 to 2.7 times that of non-Hispanic whites among older adults. In younger age groups, the rate ratio ranges vary widely, from 0.23 in very young adults ages 20 to 24 to 8.8 in the 35 to 44 age group. Some possible reasons for these racial differences may be related to differences in prevalence of risk factors, knowledge about stroke and its risk factors, and treatment in different communities. The increasing trend of stroke in the young may be more dramatic among certain ethnic groups, specifically blacks and Asian/Pacific islanders.​​

UCSF Logo UCSF Logo KP Logo