Stroke rates nearly doubled among younger adults over three decades, University of Cincinnati study finds

A University of Cincinnati study published in Neurology found that stroke incidence among adults aged 20 to 54 nearly doubled from 33.9 to 62.2 cases per 100,000 between 1993 and 2020, driven primarily by ischemic strokes. While 30-day mortality declined from 11.7% to 9.4%, risk factors including hypertension, diabetes, and marijuana use rose significantly among young patients. Researchers emphasize the urgent need for early screening as more young adults survive with potential long-term disability.

Study methodology and general trends

• ▪A University of Cincinnati study published in Neurology on September 23, 2026, analyzed 2,076 first-ever strokes among adults aged 20 to 54 in Greater Cincinnati and Northern Kentucky between 1993 and 2020.
• ▪From 1993 to 2020, stroke incidence among older adults in the same study region decreased from 618.78 cases per 100,000 to 453.04 cases per 100,000.
• ▪The stroke incidence rate among adults aged 20 to 54 nearly doubled from 33.9 cases per 100,000 in 1993–1994 to 62.2 cases per 100,000 in 2020.

Incidence trends by stroke type

• ▪Rates of intracerebral hemorrhage and subarachnoid hemorrhage strokes showed no significant increase among adults aged 20 to 54 between 1993 and 2020.
• ▪Ischemic stroke rates among adults aged 20 to 54 nearly doubled from 23.8 cases per 100,000 in 1993–1994 to 47.3 cases per 100,000 in 2020, driving the overall stroke increase.

Prevalence of medical risk factors

• ▪The University of Cincinnati study could not determine whether rising risk factors caused higher stroke rates because comparable health data was not collected for individuals without strokes.
• ▪Among young adult stroke patients in the University of Cincinnati study between 1993 and 2020, high blood pressure rates rose from 47.3% to 60.3%, diabetes from 19.1% to 25.5%, and atrial fibrillation from 1.4% to 5.9%.

Substance use trends and impact

• ▪Documented marijuana use among young adult stroke patients in the study region increased from under 1% in 1993–1994 to 30.6% in 2020, accounting for most of the overall substance use increase.
• ▪Documented substance use among stroke patients aged 20 to 54 increased from 4.6% in 1993–1994 to 40.2% in 2020.
• ▪University of Cincinnati study co-author David Robinson stated that while marijuana use is associated with cardiovascular disease, further rigorous research is required to evaluate its role as an independent stroke risk factor.
• ▪The University of Cincinnati study observed no significant changes over time in moderate alcohol use or tobacco use among younger adult stroke patients between 1993 and 2020.

Post-stroke mortality rate trends

• ▪The 30-day post-stroke death rate for adults aged 20 to 54 decreased from 11.7% in 1993–1994 to 9.4% in 2020, after adjusting for age, sex, and race.
• ▪The reduction in 30-day post-stroke mortality among young adults was predominantly driven by survival improvements among patients experiencing intracerebral hemorrhage and subarachnoid hemorrhage.