University of Cincinnati Study Finds Stroke Rates Nearly Doubled in Young Adults Across the Region

Stroke rates among adults ages 20 to 54 in the Greater Cincinnati and Northern Kentucky region have nearly doubled over the past three decades, according to new research from the University of Cincinnati that draws directly on local health data.

Researchers analyzed 2,076 first-ever strokes among adults in that age group across the region from 1993-1994 through 2020. Incidence rose from about 34 to 62 strokes per 100,000 people per year over that span. The findings were published in the journal Neurology on Sept. 23.

The study covers five counties in one state, and the region includes Hamilton, Butler, Warren, Clermont and Brown counties in Ohio along with adjoining parts of Northern Kentucky — meaning the data reflects local hospitals and residents rather than a national sample.

The increase was driven mainly by ischemic stroke, caused by a blocked blood vessel supplying the brain. Researchers also documented rising rates of hypertension, diabetes, atrial fibrillation and substance use among the younger stroke patients studied.

Substance Use Documentation Jumped Sharply

One of the starkest changes in the data was a jump in documented substance use among younger stroke patients, from 4.6% at the start of the study period to 40.2% by its end, primarily involving marijuana.

Study co-author David J. Robinson, M.D., an assistant professor of clinical neurology and rehabilitation medicine at the University of Cincinnati College of Medicine, cautioned against drawing firm conclusions from that figure.

“It’s hard to say whether this is responsible for any of the rise in stroke; there is a relationship between marijuana use and stroke, but most of the evidence is with heavier use,” Robinson said. “The relationship between marijuana use and cardiovascular disease needs more study so that we can properly advise our patients.”

Robinson said the broader cause of the rising incidence remains unclear. “We don’t know for sure why strokes are becoming more common, and we really need to study this in more depth if we are going to reverse this trend,” he said. “This has major implications, since young people who develop disability from a stroke may no longer be able to work or provide for their families.”

Older Adults Saw the Opposite Trend

While strokes climbed among the region’s younger adults, they fell among older residents, declining from roughly 619 to 453 strokes per 100,000 people per year over the same period.

Survival also improved for younger stroke patients in the region. The share who died within 30 days of a stroke dropped from 11.7% to 9.4%, an improvement researchers attributed primarily to better outcomes for bleeding-related strokes, including intracerebral and subarachnoid hemorrhages.

“Our study might provide evidence that we have gotten better at treating people who have hemorrhagic strokes and helping them survive, which is encouraging,” Robinson said. “Still, prevention is the most important thing to focus on, because just surviving a stroke doesn’t mean you aren’t left without disability.”

Outside Experts Urge Awareness

Dr. Jason A. Gluck, vice chair of the Heart & Vascular Institute and system chief of cardiology at AtlantiCare in New Jersey, who was not involved in the research, said the direction of the local trend is troubling even though stroke remains uncommon among younger people.

“The concerning findings in this particular trial is that stroke rates are moving in the wrong direction for the younger population,” Gluck said. “While many of the risk factors are things that we can identify and treat before a stroke occurs, when you’re young, sometimes you don’t know about it — so awareness is key.”

Gluck said the same conditions that raise stroke risk in older adults — high blood pressure, diabetes, smoking, obesity and abnormal cholesterol — can just as easily affect people decades younger. “Vascular disease doesn’t suddenly begin when you’re 65; it develops over time,” he said.

Researchers noted limitations in the work: it did not track comparable risk factors in people who did not have strokes, making it hard to isolate causes, and changes in medical documentation and diagnostic tools — including wider use of MRI — over nearly 30 years may have affected the numbers.

Robinson pointed to blood pressure screening as a particular gap for younger residents. “Younger people may not have a lot of opportunities to get their blood pressure and other risk factors screened, and we need to come up with solutions that can meet them where they are,” he said. He recommended the American Heart Association’s “Life’s Essential 8” checklist, which covers blood pressure control, diet, physical activity, tobacco use, sleep, weight, cholesterol and blood sugar.

Gluck advised residents to learn the “BE FAST” warning signs of stroke and to act immediately if they appear. “If you’re having these symptoms or your loved one is having these symptoms, don’t drive yourself to the hospital,” he said. “Call 911. Be fast.”