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Research article
Sarah Shali Matuja
Catholic University of Health and Allied Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7329-3922
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Background: Stroke burden in young adults is growing associated with unique risk factors and devastating outcomes. We aimed to investigate the magnitude, risk factors and outcomes of first ever stroke in young adults ≤45 years compared to older adults >45 years.
Methods: All patients with a World Health Organization clinical definition of stroke at a tertiary hospital in Tanzania were enrolled. The National Institute of Health Stroke Scale and Modified Rankin Scale were used to assess admission stroke severity and outcomes respectively. Kaplan-Meier analysis was used to describe survival and Cox-proportional hazards model was used to examine predictors of fatality.
Results: We enrolled 369 first ever stroke participants over 8 months. First strokes accounted for one quarter of medical admissions in both younger and older groups, 123/484 {(25.4%) [95% CI 21.5% - 29.3%]} and 246/919 {(26.8%) [95% CI 23.9% - 29.6%]} respectively. Hemorrhagic stroke occurred in 47 (42.3%) vs 62 (27.2%) for the young and old respectively p=0.005. Factors associated with stroke in the young were: a new diagnosis of hypertension in 33 (26.8%) vs 23 (9.3%) p<0.001, HIV infection 12 (9.8%) vs 7 (2.8%) p=0.005, use of hormonal contraception in females 33 (48.5%) vs 13 (9.4%) p<0.001, elevated serum low density lipoproteins 28 (27.7%) vs 29 (16.4%) p=0.024, hypercholesteremia 34 (31.2%) vs 40 (20.2%), p=0.031, sickle cell disease 11 (9.7%) vs 9 (4.2%) p=0.047 and thrombocytosis 12 (16.9%) vs 8 (5.6%) p=0.007. The overall 30-day fatality rate was 215 (61.3%); 57 (49.1%) vs 158 (67.2%) in the young and old respectively. Independent predictors of fatality were: severe stroke {HR 10.35 (95% CI: 1.397–76.613)}, leukocytosis {HR 2.23 (95% CI: 1.448–3.419)} and fever {HR 1.79 (95% CI: 1.150–2.776)}.
Conclusions: There is a high burden of stroke in young adults that is coupled with a high 30-day fatality rate. Screening and management of hypertension is crucial in the prevention of stroke. More research is needed to identify factors which cause death, allowing the development of sustainable interventions to reduce early post stroke fatality in this group.
Keywords
Stroke, Young adults, Burden, Risks, Hypertension, Fatality, Outcomes
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View the published article at BMC Neurology.
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Editorial decision: Minor revision
On 13 May, 2020
Reviewer #2 agreed
On 17 Apr, 2020
Reviewer #1 agreed
On 16 Apr, 2020
Review #1 received
Received 16 Apr, 2020
Reviewers invited
Invitations sent on 14 Apr, 2020
Editor assigned
On 13 Apr, 2020
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On 12 Apr, 2020
Editor invited
On 12 Apr, 2020
No comments provided
Editorial decision: Major revision
On 03 Apr, 2020
Review #3 received
Received 21 Mar, 2020
Review #2 received
Received 18 Mar, 2020
Reviewer #3 agreed
On 05 Mar, 2020
Reviewer #1 agreed
On 04 Mar, 2020
Reviewer #2 agreed
On 04 Mar, 2020
Review #1 received
Received 04 Mar, 2020
Reviewers invited
Invitations sent on 03 Mar, 2020
Editor assigned
On 25 Feb, 2020
First submitted
On 24 Feb, 2020
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A new preprint design is coming!
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See the published version of this preprint at BMC Neurology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Sarah Shali Matuja
Catholic University of Health and Allied Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7329-3922
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Neurology.
Version 2
Posted 16 Apr, 2020
No community comments so far
Review #2 received
Received 13 May, 2020
Editorial decision: Minor revision
On 13 May, 2020
Reviewer #2 agreed
On 17 Apr, 2020
Reviewer #1 agreed
On 16 Apr, 2020
Review #1 received
Received 16 Apr, 2020
Reviewers invited
Invitations sent on 14 Apr, 2020
Editor assigned
On 13 Apr, 2020
Submission checks complete
On 12 Apr, 2020
Editor invited
On 12 Apr, 2020
No comments provided
Editorial decision: Major revision
On 03 Apr, 2020
Review #3 received
Received 21 Mar, 2020
Review #2 received
Received 18 Mar, 2020
Reviewer #3 agreed
On 05 Mar, 2020
Reviewer #1 agreed
On 04 Mar, 2020
Reviewer #2 agreed
On 04 Mar, 2020
Review #1 received
Received 04 Mar, 2020
Reviewers invited
Invitations sent on 03 Mar, 2020
Editor assigned
On 25 Feb, 2020
First submitted
On 24 Feb, 2020
Submission checks complete
On 24 Feb, 2020
Editor invited
On 24 Feb, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Neurology.
Background: Stroke burden in young adults is growing associated with unique risk factors and devastating outcomes. We aimed to investigate the magnitude, risk factors and outcomes of first ever stroke in young adults ≤45 years compared to older adults >45 years.
Methods: All patients with a World Health Organization clinical definition of stroke at a tertiary hospital in Tanzania were enrolled. The National Institute of Health Stroke Scale and Modified Rankin Scale were used to assess admission stroke severity and outcomes respectively. Kaplan-Meier analysis was used to describe survival and Cox-proportional hazards model was used to examine predictors of fatality.
Results: We enrolled 369 first ever stroke participants over 8 months. First strokes accounted for one quarter of medical admissions in both younger and older groups, 123/484 {(25.4%) [95% CI 21.5% - 29.3%]} and 246/919 {(26.8%) [95% CI 23.9% - 29.6%]} respectively. Hemorrhagic stroke occurred in 47 (42.3%) vs 62 (27.2%) for the young and old respectively p=0.005. Factors associated with stroke in the young were: a new diagnosis of hypertension in 33 (26.8%) vs 23 (9.3%) p<0.001, HIV infection 12 (9.8%) vs 7 (2.8%) p=0.005, use of hormonal contraception in females 33 (48.5%) vs 13 (9.4%) p<0.001, elevated serum low density lipoproteins 28 (27.7%) vs 29 (16.4%) p=0.024, hypercholesteremia 34 (31.2%) vs 40 (20.2%), p=0.031, sickle cell disease 11 (9.7%) vs 9 (4.2%) p=0.047 and thrombocytosis 12 (16.9%) vs 8 (5.6%) p=0.007. The overall 30-day fatality rate was 215 (61.3%); 57 (49.1%) vs 158 (67.2%) in the young and old respectively. Independent predictors of fatality were: severe stroke {HR 10.35 (95% CI: 1.397–76.613)}, leukocytosis {HR 2.23 (95% CI: 1.448–3.419)} and fever {HR 1.79 (95% CI: 1.150–2.776)}.
Conclusions: There is a high burden of stroke in young adults that is coupled with a high 30-day fatality rate. Screening and management of hypertension is crucial in the prevention of stroke. More research is needed to identify factors which cause death, allowing the development of sustainable interventions to reduce early post stroke fatality in this group.
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