Stroke incidence nearly doubled among young adults from 1993 to 2020, observational study finds

An observational study published in Neurology (Fisher ER et al., doi:10.1212/WNL.0000000000218622), covered by Healio and the American Academy of Neurology around 23–24 September 2026, reports that the incidence of first-ever stroke among young adults nearly doubled between 1993 and 2020 in one U.S. region, while rates in older adults fell.

What the study measured

Researchers examined hospitalized first-ever strokes in the Greater Cincinnati/Northern Kentucky region. Young adults were defined as ages 20–54. Across periods 1993–94, 1999, 2005, 2010, 2015 and 2020, they counted 2,076 young-adult cases. Incidence rose from 33.9 to 62.18 per 100,000 person-years (P=.04). Among older adults, incidence fell from 618.78 to 453.04 (P=.02).

Ischemic stroke in young adults rose from 23.8 to 47.3 per 100,000 (P=.02); there was no clear trend for intracerebral hemorrhage or subarachnoid hemorrhage. Thirty-day case fatality among young adults declined from 11.7% to 9.4% (P=.002).

Risk factors recorded

Among young stroke patients, documented hypertension rose from 47.3% to 60.3%, diabetes from 19.09% to 25.5%, and atrial fibrillation from 1.4% to 5.9%. Substance use rose from 4.6% to 40.2%, including marijuana from 0.9% to 30.6%. Lead author Fisher and colleagues stress that the rise in substance use does not clearly prove causation and that more research is needed. Changes in diagnostics and imaging since the 1990s are a limitation.

Study type and advice

This is an observational regional study of hospitalized strokes, not a randomized trial. Findings may not generalize to every population, and association is not the same as cause. This summary is not personal medical advice; anyone with stroke symptoms or concerns about risk should seek urgent clinical care.