Strokes among adults 20 to 54 rose 83% over nearly three decades in a Cincinnati-area study

The rate of first-ever stroke among adults aged 20 to 54 in the Greater Cincinnati and Northern Kentucky region rose 83% between 1993 and 2020, from 33.9 to 62.2 cases per 100,000 person-years. The finding comes from a University of Cincinnati-led analysis of 2,076 first strokes, published in the journal Neurology on Sept. 23, 2026.

Save more, waste less: The Cool Down’s newsletter sends smart, simple changes that help you and the planet in your everyday life.

Subscribe to The Cool Down →

We may earn a commission if you sign up.

Emily R. Fisher, MD, the study’s lead author at the University of Cincinnati, summed up the trend plainly: “stroke is becoming increasingly common in younger adults.” She added that more young adults may be living with the long-term effects of stroke, a point that matters because survival has improved even as incidence climbed.

The Greater Cincinnati and Northern Kentucky Stroke Study

The data come from the Greater Cincinnati/Northern Kentucky Stroke Study, which according to the University of Cincinnati’s release has tracked stroke in a five-county region since 1993. The researchers describe the area as a small-scale model of the United States, with similar racial, educational and socioeconomic makeup, which is why a regional study is read nationally.

Per Patient Care’s summary of the paper, stroke-trained physicians reviewed hospitalized cases in six study periods: July 1993 to June 1994, then 1999, 2005, 2010, 2015 and 2020. Rates were standardized to the 2010 census population. The 2,076 first-ever strokes in adults 20 to 54 were counted across all six periods, so the 83% compares the first period with the last, not every year in between. The 83% is the proportional rise implied by the two published rates, 33.9 and 62.2 per 100,000 person-years, as ScienceDaily’s version of the American Academy of Neurology release reports them.

Person-years, the unit behind both numbers, accounts for the number of people in the population and how long they were observed, which lets rates from different periods be compared even when the region’s population changes. Fisher is described by the university as a vascular neurology fellow in its College of Medicine, and the analysis was funded through the Greater Cincinnati/Northern Kentucky Stroke Study itself.

Ischemic stroke drove the rise

Ischemic stroke, the kind caused by a blocked blood vessel supplying the brain, accounted for the increase. Its rate in the 20-to-54 group rose from 23.8 to 47.3 per 100,000 person-years, according to the American Academy of Neurology’s press release. The authors found no comparable rise for intracerebral hemorrhage, bleeding within the brain, or for subarachnoid hemorrhage, bleeding in the space around it.

The pattern ran against the experience of older adults in the same region. Patient Care reports that incidence in adults 55 and older fell over the same period, from 618.78 to 453.04 per 100,000 person-years, even though the older group still had far higher rates than the younger one in absolute terms. The opposite directions of the two trends are what make the younger group’s numbers stand out: in the same five-county region, first-stroke incidence fell among adults 55 and older while it rose among adults 20 to 54, a divergence the study reports but does not explain.

Risk factors that became more common

Among younger adults who had a stroke, high blood pressure, diabetes and atrial fibrillation, an irregular heartbeat that can let clots form in the heart and travel to the brain, all became more common over time. Substance use rose from 4.6% of patients in 1993 and 1994 to 40.2% in 2020, and the release says much of that increase reflects marijuana use.

The study cannot say those factors caused the rise. The researchers had no comparable health information from people who did not have a stroke, so they could not test how much each factor contributed. Fisher said that additional research is needed to better understand what is driving these trends and how they can be reversed.

Survival improved, and the limits of one region

Death after stroke fell slightly, and the gains were uneven across stroke types. The 30-day mortality rate, adjusted for age, race and sex, dropped from 11.7% in 1993 and 1994 to 9.4% in 2020, with the improvement mostly among people who had intracerebral or subarachnoid hemorrhage. Patient Care lists the 30-day case fatality for intracerebral hemorrhage falling from 27.5% to 21.2% and for subarachnoid hemorrhage from 27.9% to 18.6%, though the subarachnoid change was not statistically significant. Survival is not the same as full recovery, since survivors can have lasting problems with movement, speech or memory, and a stroke in the 20s, 30s or 40s can mean decades of living with them.

One limit is geographic. The data come from a single area, and the American Academy of Neurology notes the results may not apply nationwide. Fisher said the findings point to the importance of identifying and managing stroke risk factors early in adulthood, which is the practical message the authors take from a trend they cannot yet fully explain. The paper is indexed under DOI 10.1212/WNL.0000000000218622.

This article was produced with the assistance of AI and reviewed by Morning Overview editors prior to publication.

Save more, waste less: Subscribe to The Cool Down →

We may earn a commission if you sign up.