Reversing progress, stroke rates are rising, especially in working-age adults

Stroke prevalence has been climbing over the past decade, reversing a steady decline among all Americans while rising the most among adults under 65, a new CDC analysis reports.

Strokes still strike more adults older than 65, but the increase at younger ages mirrors another recent turnaround: rates of heart failure deaths, which had been dipping, are rising the most in adults under 45.

The rising prevalence comes even though medicines to tamp down such risk factors as hypertension and high cholesterol, as well as technologies to treat strokes, are much more available in wealthier countries like the U.S. than elsewhere around the world.

Stroke rates in the United States had fallen by 3.7% during a five-year stretch ending in 2010, but they headed back up by 7.8% through 2022. The increase was nearly double — 15% — for adults younger than 65. Thursday’s Morbidity and Mortality Weekly Report broke it down further to a jump of 14.6% among adults age 18 to 44 and 15.7% among those age 45 to 64.

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

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

The report’s authors, from CDC’s Division for Heart Disease and Stroke Prevention, noted that the increasing prevalence corresponds with a rise of cardiovascular risk factors among younger, working-age adults during recent decades.

They compared two, two-year time periods: Obesity prevalence among men increased from 27.5% in 1999 and 2000 to 43% in 2017 and 2018; among women it rose from 33.4% to 41.9%. By 2018, obesity prevalence was highest among those aged 40 to 59 years old (44.8%). High blood pressure prevalence was highest among adults 45 to 64 years old, rising from 40.3% during 1999 and 2000 to 46.8% during 2017 and 2018.

There was another factor to consider: opioids. Hospitalizations for strokes related to opioid use and infective endocarditis, a life-threatening infection of the heart’s lining and valves, increased in people under 45 from 2006 through 2015, coinciding with the opioid epidemic’s onset, the authors added.

The Covid-19 pandemic, however, seems not to have made a difference, with no significant changes detected in the prevalence of stroke pre- and post-pandemic.

Ethnic and racial disparities persisted. Stroke rates were higher among American Indian or Alaska Native, Native Hawaiian or Pacific Islanders, and Black adults than white adults. Education was linked to stroke rates, too: Prevalence among adults with less than a high school diploma was roughly three times higher than for adults with college degrees.

Mass General’s Kimberly tied the increased prevalence among some racial and ethnic groups, as well as those with different education levels, to less access to healthcare.

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

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

As with rising heart failure deaths, it’s possible that because people are living longer, more of them are developing serious cardiovascular problems. In strokes, it’s possible that people are surviving a first stroke, thanks to greater awareness of the warning signs, and then living to have another one.

Among all racial and ethnic groups, more people are getting treatments to break up the blood clots that can cause ischemic strokes, from 10% to 15% during 2003 to 2009, to 43% to 46% in 2021. Still, disparities remained. Asian, Black, and Hispanic patients were less likely than white patients to get to the hospital within 4.5 hours of ischemic stroke onset and also less likely to receive those treatments.

“Better recognition of stroke signs and symptoms might have potentially contributed to increased stroke prevalence, because earlier stroke treatment contributes to improved outcomes,” the authors wrote. “Initiatives to promote knowledge of the signs and symptoms of stroke, and identification of disparities in stroke prevalence, might help effectively focus interventions to improve stroke prevention and treatment.”

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.