Abstract
Background: While there have been dramatic declines in the incidence of cardiovascular diseases in older adults, the incidence of strokes and acute myocardial infarctions (AMI) in young adults are as high as ever. The goal of this study was to better understand sex differences in the incidence of stroke and AMI in young adults. Methods: A 10% random sample of all enrollees from a commercial claims database between 2001-2014 was used. Enrollees between 15 to 45 years old with claims for first ever stroke or AMI hospitalizations identified by ICD-9 code were included. Logistic regression was used to quantify incidence over time, adjusting for age groups and sex, also allowing for sex and year interaction (so women and men can have trends in opposite directions). Results: Among 3,717,422 young adults, there were 3357 incident stroke and 2986 incident AMI hospitalizations. The average age based on first year of enrollment was 28.6 with a mean 3.6 years of follow-up. There were 52.0% women overall. Women were more likely than men to be admitted for stroke (55.2% vs. 44.8%; p=0.0003) but less likely to be admitted for AMI (30.7% vs. 69.3%; p<0.0001). In the logistic model for trend, there was a slight but significant increase in stroke incidence overtime (OR 1.014 95% CI 1-1.027), but not in AMI (OR 1.011 95%CI 0.992-1.03). There is a 2.8 fold increased in the odds of AMI in men (95%CI 2.343-3.305) and a 0.912 decrease in the odds of stroke in men which was not significant (95% CI 0.783-1.062). The incidence of AMI in men declined overtime (OR 0.984 95%CI 0.961-1.006) but did not reach significance (figure). Conclusions: In the young adult population, AMI is more common in men and stroke is more common in women. The explanation for this difference is unclear but suggests there may be different etiologies of stroke and AMI in young adults. Further research could help to better define the varying role of atherosclerotic risk factors in young adults with stroke as compared with AMI.
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