Stroke Rates Are Rising in Younger Adults, as Older Populations See Declines: Emily R. Fisher, MD

Stroke has long been framed as a disease of older age—but that mental model is increasingly out of step with emerging data. At the International Stroke Conference 2026, Emily R. Fisher, MD, a medical resident and Neurology and Rehabilitation fellow at the University of Cincinnati College of Medicine, presented new population-based findings showing that stroke incidence among adults aged 20 to 54 nearly doubled between 1993 and 2020, even as rates declined in older adults.

Drawing on nearly 3 decades of surveillance data from the greater Cincinnati–northern Kentucky region, Fisher’s work highlights a troubling rise in ischemic stroke among younger adults that coincides with increasing documentation of traditional vascular risk factors and substance use, alongside modest improvements in short-term survival. In this interview, Fisher reflects on how these trends should reshape thinking around stroke prevention, detection, and long-term impact in younger populations, and what clinicians, health systems, and policymakers may need to reconsider as stroke increasingly affects people in the prime of their lives.

This transcript was lightly edited; captions were auto-generated.

Transcript

From your perspective, how should clinicians and health systems rethink their mental model of stroke risk as it increasingly affects adults in their 20s, 30s, and 40s?

Yeah, that's a great question. So some of the work I presented at the conference was about the rising incidence rate of stroke in young adults over the last 27 years or so in our study period. The proportion of stroke in young adults still remains small compared to older adults, so maybe 15% or so, depending on what you're looking at. But I think what this highlights is the importance of primary prevention, so even before you have a medical condition, making sure at a younger age you’re established with a primary care physician to be monitoring for those vascular risk factors like high blood pressure, high cholesterol, etc, to make sure that we're targeting those things when we're still able to modify them before stroke.

The incidence of stroke in younger adults nearly doubled over the study period—how do you personally weigh the role of changing risk profiles vs improved detection in explaining that magnitude of increase?

That's a great question too, and that's something that's a little hard to discern with the nature of our work, which is looking at the medical record and abstracting chart information. You're certainly right that we are probably better at diagnosing and documenting things like high blood pressure and high cholesterol now than we were 27 years ago. But I will say, we've seen this reflected in several other studies that have had different methodologies than ours. I do believe that there is at least some signal that there's a rise in these traditional risk factors over time. We didn't capture this variable of obesity or metabolic syndrome in our study, but we do know that it’s rising over time as well and does seem to coincide with a lot of these other risk factors.

Despite rising incidence, 30-day case fatality declined modestly in younger adults—what does that say about where acute care has succeeded and where gaps remain?

We see that the minor but present trend in the 30-day mortality, or case fatality rate, for young adults with stroke is mainly driven by bleeding strokes, so mainly intracerebral hemorrhage and somewhat subarachnoid hemorrhage. We've got more work that we'll be presenting in the paper that comes out about this topic, as to maybe some reasons for those 2 particularly having a declining case fatality rate, but one possibility is, certainly, that our systems of care are better caring for folks in dedicated neurosurgical and neurological ICUs.

How do you hope clinicians, payers, or policymakers will act differently after engaging with these results?
I think this shows a really concerning trend that young adults in our population are having more strokes, and that not only affects them acutely, but it also affects them oftentimes for the rest of their lives. So, everything we can do to focus on primary prevention and therapeutics for these folks after they suffer a stroke will continue to be really important.

Reference

Fisher ER, Ding L, Stanton RJ, et al. Temporal trends in the incidence and case fatality rates of stroke in the young: a population-based study. Presented at: International Stroke Conference 2026. February 3-6, 2025; New Orleans, LA. Abstract A010.