Stroke rates in people under 55 have risen over recent decades even as rates in older adults have fallen. In England, stroke incidence among 35- to 54-year-olds rose by about 2% yearly between 2001 and 2010. In the US, stroke rates in 20- to 54-year-olds climbed from 34 to 62 cases per 100,000 people per year between 1993-1994 and 2020. Globally, nearly 2.8 million people under 55 had a stroke in 2021, with about 90% occurring in low- and middle-income countries.
An international study identified ten modifiable risk factors that accounted for around 92% of strokes in people under 55. These included high blood pressure, physical inactivity, high cholesterol, poor diet, obesity, smoking, heart problems, diabetes, alcohol consumption and psychosocial factors. High blood pressure alone accounted for almost half of strokes in people aged 55 and under. Lack of regular exercise accounted for more than a third.
A UK study examining 1,765 people aged 18-49 hospitalized for stroke found 42% had high blood pressure, 24% high cholesterol, 23% smoked and 14% had diabetes. About 7% reported recreational drug use.
Research shows that people under 55 with diabetes were about 3.5 times as likely to suffer a stroke as those without it. Those with high blood pressure were about 2.5 times as likely.
Strokes in younger adults may present differently than in older adults. Strokes at the back of the brain, more common in young adults, can cause problems with balance or eyesight, headache, neck pain or vertigo rather than facial drooping or arm weakness. Young people may mistake these symptoms for migraine, tiredness, a hangover or inner ear problems.
People aged 18-44 were the age group most likely to be sent home from emergency departments with a missed stroke, often after complaining of dizziness or headache. A Stroke Association survey found a quarter of stroke survivors aged 60 and under said they were initially misdiagnosed.
Clot-busting treatment must generally be given within 4.5 hours of symptoms starting. The sooner treatment is given, the better the outcome and recovery.