Stroke Admissions Climb in Under-65s

I would argue that the simplistic reflex argument that prevention efforts are the main way to combat this problem is wrong. By not focusing on better rehabilitation your stroke leaders are leaving those who still get a stroke with the 90% failure rate of full recovery.
http://www.medpagetoday.com/Cardiology/Strokes/57926?xid=NL_breakingnews_2016-05-16&eun=g424561d0r

• by Jeff Minerd
  Contributing Writer, MedPage Today

  Hospitalizations for ischemic stroke have increased in younger adults, according to two registry-based studies.
  In the U.S., acute ischemic stroke hospitalizations increased by almost 44% in adults, ages 25-44, during 2000-2010, but fell by more than 20% in those 65 and older, reported Lucas Ramirez, MD, of the University of Southern California in Los Angeles, and colleagues.
  In a separate study done in Denmark, hospitalizations increased by nearly 2% for stroke and approximately 4% for transient ischemic attack (TIA) in individuals, ages 15-30, from 1994-2012, according to Maiken Tibaek, a PhD candidate at the University of Copenhagen, and colleagues.
  Both studies appear in the Journal of the American Heart Association.
  "Overall, the hospitalization rate is down, with the greatest drop in people aged 65 and older," Ramirez said in an accompanying press release. "We can't say from this study design what factors have led to this decline, but it may be that preventive efforts, such as better blood pressure and blood sugar control, are having the effect that we want in this age group."
  "Stroke and transient ischemic attacks rarely occur in the young but may have a profound and long-lasting impact for the individual if they do," Tibaek said in a statement. "Compared to elderly individuals, strokes in the young may have greater economic impact because it impairs the ability to work during the most productive years of life."
  "For healthcare providers and patients, this study confirms the importance of focusing on prevention and addressing lifestyle-related risk factors to prevent stroke," Tibaek added. "It's also important that clinicians who see young adults with symptoms of stroke are aware that stroke is not that rare a diagnosis in younger adults."
  The U.S. Study
  Ramirez and colleagues analyzed data from the Nationwide Inpatient Sample, a database that includes information on approximately 8 million U.S. hospital stays per year, and represents a 20% stratified sample of non-federal U.S. hospitals.
  The investigators assessed trends in hospitalizations for stroke by age, sex, and race from 2000-2010.
  They found that overall hospitalization rates for stroke decreased by 18.4%. Specifically, rates decreased by 28.5% for adults (ages 65-84) and by 22.1% for adults 85 and older.
  However, rates increased by 43.8% for adults (ages 25-44) and by 4.7% for those 45-64.
  Also, rates decreased for Hispanics (-21.7%) and whites (-12.4%) but increased by 13.7% for blacks.
  Finally, rates decreased more for women (-22.1%) than men (-17.8%).
  Most of the decline in hospital admissions for stroke occurred during 2000-2005, with the figures plateauing after that. "The plateau from 2005 to 2010 could reflect a threshold beyond which our current prevention efforts are no longer having an effect..." Ramirez and colleagues wrote.
  The study had some limitations, namely that it was an observational study so causality cannot be assumed. Also, there was the possibility for coding errors, such as TIA miscoded as acute ischemic stroke. Lastly, because of demographic differences between the database and census data, acute ischemic stroke rates may have been underestimated in Hispanics, due to an inflated denominator when estimating the rate, the authors explained.
  "Our findings should be interpreted with caution," the U.S. investigators wrote, "since changes in stroke hospitalization rates are affected not only by true changes in incidence, but also stroke literacy and health beliefs (influencing likelihood of seeking medical attention), pre-hospital recognition and triage of patients with stroke symptoms, and hospital protocols/healthcare provider literacy (affecting the likelihood of hospitalizing individuals with stroke symptoms).
  "Nevertheless, the decline in stroke hospitalization rates could reflect reduced incidence, possibly due to cardiovascular prevention efforts, which have led to improved blood pressure and cholesterol treatment and control," Ramirez and colleagues concluded.
  The Danish Study
  Tibaek and colleagues analyzed data from the Danish National Patient Register, which includes all hospitalizations in Denmark since 1977. The investigators examined rates of first-time hospitalizations for stroke and TIA in people (ages 15-30) from 1994-2012.
  Incidence rates and estimated annual percentage changes (EAPCs) were estimated by using Poisson regression, the authors explained.
  During the study period, there were 4,156 cases of first-ever hospitalization for stroke/TIA identified.
  The age-standardized incidence rates of hospitalizations for stroke increased significantly (EAPC 1.83%. 95% CI 1.11–2.55%) from 11.97/100,000 person-years in 1994 to 16.77/100,000 person-yearsin 2012.
  TIA hospitalizations increased from 1.93/100,000 person-years in 1994 to 5.81/100,000 person-years in 2012. After 2006, the increase was more prominent in men than in women (EAPC 16.61%, 95% CI 10.45–23.12%).
  However, the incidence of hospitalizations for ischemic stroke was markedly lower among men, but increased significantly from 2006 (EAPC 14.60%, 95% CI 6.22–23.63%). Also, the incidences of hospitalizations for intracerebral hemorrhage and subarachnoid hemorrhage remained stable during the study period.
  "If the increase in ischemic stroke and transient ischemic attack is caused by changes in the overall cardiovascular risk profile of young adults, such as the increased prevalence of diabetes and obesity, our results can be applied to other countries with similar trends in cardiovascular risk profiles including the United States," Tibaek said.
  Study limitations included the the use of register-based design that tracked only hospitalized cases of stroke and TIA.
  
  The U.S. study was funded by the Roxanna Todd Hodges Foundation.
  The Danish study was funded by the Danish Ministry of Health and the Capital Region of Denmark.
  Ramirez and co-authors disclosed no relevant relationships with industry. One co-author disclosed support from the National Institute of Neurological and the American Heart Association.
  Tibaek and co-authors disclosed no relevant relationships with industry.
• Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College

• Primary Source

  Journal of the American Heart Association

  Source Reference: Tibaek M, et al "Increasing incidence of hospitalization for stroke and transient ischemic attack in young adults: a registry-based study" J Am Heart Assoc 2016; DOI: 10.1161/JAHA.115.003158.

• Secondary Source

  Journal of the American Heart Association

  Source Reference: Ramirez L et al "Trends in acute ischemic stroke hospitalizations in the United States" J Am Heart Assoc 2016; DOI: 10.1161/JAHA.116.003233.

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