Abstract
Introduction: The rise of ischemic stroke among young adults has stressed the need to understand their risk profiles and outcomes better. This study aimed to examine the five-year ischemic stroke recurrence and survival probability among young patients in rural Pennsylvania. Methods: This retrospective cohort study included first-time ischemic stroke patients from the Geisinger Health System between September 2003 and May 2014. The outcomes included all-cause mortality and ischemic stroke recurrence at five years. Kaplan-Meier estimator, cumulative incidence function, Cox proportional hazards model, and Cause-specific hazard model were used to examine the association of independent variables with the outcomes. Results: A total of 4459 first-time ischemic stroke patients were included in the study, with 664 (14.9%) patients in the 18–55 age group and 3795 (85.1%) patients in the >55 age group. In the 18–55 age group, the five-year survival probability was 87.2%, and the cumulative incidence of recurrence was 8%. Patients in the 18–55 age group had significantly lower hazard for all-cause mortality (HR = 0.37, 95% CI 0.29–0.46, p < 0.001), and non-significant hazard for five-year recurrence (HR = 0.81, 95% CI 0.58–1.12, p = 0.193) compared to the >55 age group. Chronic kidney disease was found to be associated with increased mortality in the 18–55 age group. Conclusion: In our rural population, younger ischemic stroke patients were at the same risk of long-term ischemic stroke recurrence as the older ischemic stroke patients. Identifying the factors and optimizing adequate long-term secondary prevention may reduce the risk of poor outcomes among younger ischemic stroke patients.
Highlights
The rise of ischemic stroke among young adults has stressed the need to understand their risk profiles and outcomes better
Patients were included in the Geisinger NeuroScience Ischemic Stroke (GNSIS) database if they had a primary diagnosis of ischemic stroke based on International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification (ICD-9/10-CM) codes, had brain magnetic resonance imaging (MRI) in the same encounter, and had at least one overnight stay at the hospital
In the CSHM Model 3 (CSHM3), only patients in the 18–55 age group were included, and age was not found to be significant (HR = 0.99, 95% confidence interval (CI) 0.96–1.04, p = 0.98)
Summary
The rise of ischemic stroke among young adults has stressed the need to understand their risk profiles and outcomes better. This study aimed to examine the five-year ischemic stroke recurrence and survival probability among young patients in rural Pennsylvania. The outcomes included all-cause mortality and ischemic stroke recurrence at five years. Identifying the factors and optimizing adequate long-term secondary prevention may reduce the risk of poor outcomes among younger ischemic stroke patients. The reported mortality rates in young stroke patients from different studies have been varied, ranging from around 10% at 5 years to more than 20% at 20 years [5–8]. Studies on long-term recurrence risk among young stroke patients are relatively scarce. Varona et al reported a recurrence rate of 25% in a cohort of ischemic stroke patients aged 15 to 45 years with a mean follow-up of 12.3 years [8].
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