Stroke rates among men and women ages 35 to 44 appear to have risen steadily between 1995 and 2012, according to a study published last week in JAMA Neurology—but an accompanying editorial questions whether the rate increases reflect a "true epidemiologic trend."
For the study, CDC researchers analyzed hospitalization data spanning 1995 to 2012 from the National Inpatient Sample to examine acute stroke hospitalization rates. The researchers also used hospitalization data from 2003 to 2012 to identify the prevalence of associated risk factors for acute strokes among adults between ages 18 to 64.
The researchers found that the hospitalization rates for acute ischemic stroke (AIS) increased significantly for both men and women ages 18 to 54 during the study period, particularly among men ages 18 to 44, whose AIS hospitalization rates nearly doubled from 1995 to 2012.
When focusing on more detailed data spanning from 2003 through 2012, the researchers found that AIS hospitalization rates increased by nearly 42 percent among men ages 35 to 44 and by 30 percent among women in that age group. Overall, the researchers estimated that there were nearly 30,000 more AIS hospitalizations among men and women ages 18 to 54 in 2012 than there were in 2003.
Further, the researchers found that the prevalence common stroke risk factors—including diabetes, hypertension, lipid disorders, obesity, and tobacco use—increased among men and women of all age groups during the study period, with individuals with three or more such risk factors nearly doubling from 2003 to 2012. The researchers hypothesized that the rise in risk factor prevalence is linked to the increase in AIS hospitalizations.
Overall, the researchers said the findings should "serve as a call to action to focus on improving the health of younger adults." They added, "Identifying the high and rising prevalence of stroke risk factors among younger adults presenting with acute stroke should prompt a sense of urgency among younger adults, public health practitioners, clinicians, and policymakers to engage adolescents and their families, as well as younger adults, to identify and treat stroke risk factors and promote opportunities that allow for healthy lifestyles to prevent the tragedy of stroke at such early ages."
Similarly, Diana Greene-Chandos, a neurologist and director of neuroscience critical care at The Ohio State University Wexner Medical Center who was not involved in the study, said the findings should serve as "an important call to … stroke neurologists and critical-care neurologists to start to study this more and more."
However, in an accompanying editorial James Burke and Lesli Skolarus of the University of Michigan-Ann Arbor, wrote that there is "uncertainty" surrounding the findings because they could reflect changes in the way strokes are recorded for administrative purposes or more accurate coding. They called on the stroke community to develop more accurate surveillance systems that rely on more widespread epidemiologic data before taking "urgent action."
Mary George, a CDC researcher who led the study, defended her team's findings, pointing to additional data that suggest the increase in stroke cannot be attributed to coding or reclassification changes (Naqvi, "To Your Health," Washington Post, 4/15; Hughes, Medscape, 4/12; George et al., JAMA Neurology, 4/10).
Create a super-utilizer program
Every population health manager develops a strategy to manage high-risk, high-cost patients. Many of these super-utilizer programs start small, but as they expand, leaders take the opportunity to re-evaluate program design—from appropriate patient recruitment through graduation.
This guide offers a blueprint for implementing a super-utilizer program and measuring success across six steps.