Stroke prevalence increased among younger, middle-aged adults from 2011 to 2020

Key takeaways:

• Stroke prevalence increased 14.6% from 2011 to 2022 among those aged 18 to 44 years.
• Stroke prevalence also increased by 16.1% and 7.8% among Hispanic and Black adults, respectively.

Stroke prevalence increased more than 15% among Americans aged 65 years and younger in the last decade, research published in MMWR showed.

According to Omoye E. Imoisili, MD, a medical officer at the CDC, and colleagues, stroke is a leading cause of morbidity in the United States “and was the fifth leading cause of death in 2021.”

In the study, the researchers assessed stroke prevalence trends from 2011 to 2022 using Behavioral Risk Factor Surveillance System (BRFSS) data. The respondent sample sizes ranged from 1,419,351 in 2011 to 2013 to 1,220,972 from 2020 to 2022.

Overall, age-standardized stroke prevalence increased by 7.8% from 2011 to 2013 to 2020 to 2022, which Imoisili and colleagues said contrasted to a decrease of 3.7% that was seen from 2006 to 2010.

During 2020 to 2022, stroke prevalence was highest among adults aged 65 years and older (7.7%) and lowest among those aged 18 to 44 years (0.9%).

During the study period, stroke prevalence increased by:

• 14.6% among adults aged 18 to 44 years;
• 15.7% among those aged 45 to 64 years;
• 9.3% among women; and
• 6.2% among men.

Among Hispanic, Black and white adults, stroke prevalence increased by 16.1%, 7.8% and 7.2%, respectively.

The largest percentage increase was among adults who had less than a high school education, at 18.2%.

There were statistically significant increases in stroke prevalence in 10 states, with the largest increases in Ohio (20.9%) and Tennessee (20.7%). Additionally, states in the highest quintile of stroke prevalence from 2020 to 2022 were mostly in the South.

Based on the findings, racial and ethnic disparities, education level inequality and other sociodemographic disparities “might be important to consider when developing focused interventions addressing stroke prevalence,” the researchers wrote. Such interventions can include those that raise awareness of stroke signs and symptoms, like the “Act F.A.S.T.” questions:

• Face: Does one side of the face droop when smiling?
• Arms: Does one arm drift downward when both arms are raised?
• Speech: Is speech slurred or strange when repeating a simple phrase?
• Time: If you see any of these signs, call 9-1-1 right away.

“Acting F.A.S.T is key to stroke survival,” Imoisili and colleagues wrote. “Awareness and knowledge of stroke signs and symptoms have increased among U.S. adults, although there is room for improvement.”

They added that better recognition of stroke symptoms and signs may have contributed to the increased stroke prevalence, “because earlier stroke treatment contributes to improved outcomes.”

There were some study limitations. For example, BRFSS data were self-reported and thus may have been susceptible to social desirability and recall biases.

Ultimately, “advancing focused evidence-based practices and programs for stroke awareness, prevention, and treatment is essential for improving the cerebrovascular health of the nation,” the researchers concluded.