Stroke Incidence Nearly Doubled Among Adults Younger Than 55 Over 3 Decades

The incidence of first-ever stroke among adults aged 20 to 54 years rose from 33.90 to 62.18 cases per 100 000 person-years between 1993–1994 and 2020 in a 5-county region of Greater Cincinnati and Northern Kentucky, according to a population-based study published online in Neurology. The increase was driven largely by ischemic stroke, even as 30-day case fatality declined.¹

Across 6 study periods, investigators identified 2076 first-ever strokes in this age group. The upward trend in young adults was statistically significant (P = .04), while stroke incidence among older adults fell from 618.78 to 453.04 cases per 100 000 person-years (P = .02).¹

“While stroke has traditionally been considered a disease of older adults, our findings show that stroke is becoming increasingly common in younger adults,” lead author Emily R. Fisher, MD, a vascular neurology fellow at the University of Cincinnati, said in a news release.²

Ischemic Stroke Drove the Increase

Using data from the Greater Cincinnati Northern Kentucky Stroke Study, researchers identified hospitalized stroke cases during July 1993 through June 1994 and in calendar years 1999, 2005, 2010, 2015, and 2020. Stroke-trained physicians adjudicated cases, and investigators calculated incidence rates using US Census data standardized to the 2010 population.¹

Ischemic stroke incidence among adults aged 20 to 54 years increased from 23.8 to 47.3 cases per 100 000 person-years over the study period (P = .02 for trend). The investigators did not observe comparable increases in intracerebral or subarachnoid hemorrhage.¹˒²

Hypertension, diabetes, atrial fibrillation, and substance use also became more common over time among young adults who had a stroke (P < .001). Substance use in this group increased from 4.6% in 1993–1994 to 40.2% in 2020; much of the increase reflected marijuana use, according to the release.¹˒² Those figures describe patients with stroke and do not establish that changes in any of these factors caused the rise in population stroke incidence.

Fewer Patients Died Within 30 Days

The 30-day case fatality rate among young adults decreased from 11.7% in 1993–1994 to 9.4% in 2020 (P = .002 for the adjusted trend). The decline was largely associated with hemorrhagic stroke: intracerebral hemorrhage case fatality fell from 27.5% to 21.2% (P = .03 for trend), while subarachnoid hemorrhage case fatality fell from 27.9% to 18.6%; the latter trend was not statistically significant (P = .09).¹

The study did not include comparable risk-factor data from people without stroke, limiting the investigators’ ability to determine what drove the incidence increase. Its findings come from a single 5-county region, although the researchers describe the region as broadly representative of the US in race, education, and socioeconomic status.²

For primary care physicians, the diverging trends underscore the need to assess and manage vascular risk factors during early adulthood, the authors said. The increase in stroke incidence alongside lower short-term case fatality also points to a growing number of younger adults who may live with the long-term effects of stroke.²

References

1. Fisher ER, Ding L, Stanton RJ, et al. Stroke in the young: incidence, 30-day case fatality rates, and risk factors over time in a population-based study. Neurology. Published online September 23, 2026. doi:10.1212/WNL.0000000000218622
2. Tedeschi T. More young adults are having strokes than three decades ago: UC study. University of Cincinnati. September 23, 2026.