Trends, risk profiles, and outcomes of ischemic stroke in young adults: a population-based analysis using the...

Ischemic stroke in young adults is an emerging public health concern, with rising incidence and complex etiological profiles. Unlike older populations, young stroke survivors face decades of disability, socioeconomic burden, and healthcare dependency. However, national-level data on trends, risk factors, and clinical outcomes in this demographic remain limited.

To evaluate temporal trends, clinical characteristics, and outcomes of ischemic stroke in young adults aged 18-50 years using a nationally representative inpatient dataset from 2010 to 2022, and to identify predictors of in-hospital mortality and poor discharge outcomes.

A retrospective cohort study was conducted using the National Inpatient Sample (NIS). Young adults hospitalized with a primary diagnosis of ischemic stroke (ICD-9: 434.x, 436; ICD-10: I63.x) were included. Patients with hemorrhagic stroke or trauma-related admissions were excluded. Demographic variables, vascular risk factors (hypertension, diabetes, dyslipidemia, atrial fibrillation, substance use), and outcomes (mortality, discharge disposition, length of stay, total charges) were extracted. Joinpoint regression was used to assess temporal trends; multivariable logistic regression identified predictors of mortality and poor discharge disposition. Survey weights were applied to ensure national representativeness.

The study included 3,000 young-adult ischemic stroke hospitalizations (2010-2022). Hospitalization rates increased with a 2016 joinpoint: APC +4.1% (95% CI 2.9-5.4, p < 0.001) during 2010-2016, then +2.3% (95% CI 0.8-4.1, p = 0.005) thereafter. Risk factors were common, hypertension 35.4%, diabetes 24.2%, substance use 15.8%. In-hospital mortality 2.7%; post-acute/institutional discharge 30.0%. In adjusted models, atrial fibrillation predicted mortality (OR 1.87, 95% CI 1.07-3.27; p = 0.028), while diabetes predicted non-home discharge (OR 1.26, 95% CI 1.07-1.48; p = 0.006); Medicare (OR 1.28, 95% CI 1.04-1.56; p = 0.019) and uninsured status (OR 1.38, 95% CI 1.13-1.68; p = 0.001) also increased odds of non-home discharge. Mean length of stay 5.5 days: inflation-adjusted mean charges $34,907 (2022 USD) overall-$35,348 in 2010-2016 vs. $34,382 in 2017-2022.

Ischemic stroke among young adults is increasing in incidence and driven by both traditional and non-traditional vascular risk factors. Clinical outcomes are influenced by comorbidity burden and socioeconomic disparities. These findings underscore the urgent need for targeted stroke prevention strategies and equitable post-acute care pathways in this vulnerable population.