High incidence of stroke in young adults in Tartu, Estonia, 2013 to 2017: A prospective population‐based study

• Published in: European journal of neurology Vol. 28; no. 6; pp. 1984 - 1991
• Main Authors: Kõrv, Liisa, Vibo, Riina, Mallene, Sandra, Kõrv, Janika
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.06.2021
• Subjects: Age; case fatality; Confidence intervals; Electronic health records; Electronic medical records; epidemiology; Estonia; Fatalities; Hemorrhage; incidence; Ischemia; Men; Population studies; Population-based studies; Stroke; Subarachnoid hemorrhage; Women; Young adults; Estonia; epidemiology; case fatality; incidence; stroke; Estonia
• ISSN: 1351-5101; 1468-1331; 1468-1331
• DOI: 10.1111/ene.14812

Background and purpose Previous studies conducted elsewhere in the world have demonstrated an increase in the incidence of ischemic stroke (IS) in younger ages. We sought to determine stroke incidence and 28‐day case‐fatality rates in 15‐ to 54‐year‐old residents of Tartu, Estonia from 2013 to 2017. Methods All stroke cases that were the first ever in a lifetime (IS, nontraumatic intracerebral hemorrhage [ICH], and subarachnoid hemorrhage [SAH]) in 15‐ to 54‐year‐old residents of Tartu, Estonia were prospectively registered from January 1, 2013 to December 31, 2017. Several additional overlapping data sources were used for case ascertainment including other departments of the Tartu University Hospital and outpatient clinic, Estonian Cause of Death Registry, and the Estonian Electronic Health Record. All cases were thoroughly validated before inclusion. Results We identified 110 cases (43.6% female) of first‐ever stroke (IS 72.7%, ICH 12.7%, SAH 14.6%), out of which 85.5% were included prospectively. The mean age at onset was 44.3 ± 8.5 (SD) years. The mean age at onset was higher for men than for women (p = 0.046). The incidence of stroke standardized to the 1976 European standard population (EUR) was 46.1/100,000 (95% confidence interval [CI]: 37.4–54.8). IS incidence was 33.4/100,000 EUR (95% CI: 26–40.7). The total stroke incidence was higher in 45‐ to 54‐year‐old men than in women in the same age group (rate ratio, 2.24; 95% CI: 1.35–3.71). There were no more significant differences between sexes or age groups. The 28‐day case‐fatality rate was 10.9% for all strokes. Conclusions Our study shows higher crude incidence and case fatality of stroke in the young compared to studies from other high‐income countries. A prospective population‐based study was conducted from 2013 to 2017 to determine the incidence and case fatality rate of first‐ever stroke in 15‐ to 54‐year‐old residents of Tartu, Estonia. We used several overlapping data sources for case ascertainment, and 110 cases were registered (ischemic stroke 72.7%, intracerebral hemorrhage 12.7%, subarachnoid hemorrhage 14.6%). Crude stroke incidence rate was 38/100,000 (95% confidence interval: 31.2–45.8), and the 28‐day case‐fatality rate was 10.9%.