Researchers call for better surveillance systems to track stroke incidence over time

During the past several years, stroke mortality rates have declined thanks to hypertension control, quality improvement programs, evidence-based care and increased medication use.

At the same time, younger adults are increasingly getting hospitalized for strokes, according to a recent database analysis.

The researchers, who published their findings in JAMA Neurology on April 10, found that acute ischemic stroke hospitalizations rates increased 30 percent among women and 41.5 percent among men who were between 35 and 44 years old between 2003 and 2012. In 2012, there were nearly 30,000 more stroke hospitalizations than there were in 2003.

Still, James F. Burke, MD, MS and Lesli E. Skolarus, MD, MS, wrote in an accompanying editorial that the increases might not be as eye-opening as they appear at first glance.

“If these findings represent a true epidemiologic trend, understanding the reasons underlying this trend and seeking to reverse it should be a leading priority of the stroke community,” they wrote. “However, it is not yet clear whether such urgent action is needed.”

Burke and Skolarus noted that population growth alone accounts for approximately 15,000 additional strokes per year in the younger age category. They also mentioned that the researchers gathered data from the National Inpatient Sample (NIS), a publicly available database of hospital inpatient stays in the U.S. Thus, they speculated that the accuracy of counting strokes could be questioned because of changes in stroke terminology and care from 2003 to 2012.

The researchers also found that younger adults had an increase in vascular risk factors such as hypertension, lipid disorders tobacco use and obesity, although Burke and Skolarus wrote that the increase could be due in part to more accurate coding.

“If, ultimately, stroke in the young is truly increasing and many of these strokes were preventable, it would represent a massive failure not only of our health care system, but also our stroke surveillance systems for failing to clearly detect the trend and enable it to be acted on,” they wrote. “Developing better surveillance systems, then, should be a priority of the stroke research community. A number of potential solutions exist: collecting more widespread epidemiologic data, harmonizing and building cooperation between existing epidemiological studies, or developing more reliable administrative- or electronic medical record–based surveillance systems. As the richest health care system on the planet, the answer to the question of whether stroke in the young is increasing should never be ‘Maybe.’ The authors of the present study should be commended for their effort to help resolve this uncertainty.”