Background: The overall stroke incidence among young adults is increasing. Our objective was to provide contemporary report on stroke severity, risk factors, complications and outcomes of young adults with ischemic stroke (IS) in Ontario. 

Methods: We collect information on demographics, risk factors, stroke severity, care/management and on clinical outcomes from the Ontario Stroke Registry (OSR) on adults (18-50yrs old) presenting with an acute stroke at participating facilities (2003-2013). Using t-tests for continuous and Chi-square tests for categorical variables we performed comparisons analysis across gender and two age categories (18-39vs.>40-50). The time-to-event outcomes (TIA, stroke, MI, composite vascular outcomes and death at 30-days and 1-year) were analyzed using Cox proportional hazards.

Results: We identified 2,247 patients with IS. Stroke severity was equal in all groups (63%minor and 13.1%severe). Young man had significantly (p<.001) higher frequency of risk factors compared to women [smoking (42.9 vs.29.8%), heavy alcohol use (7.2 vs.1.9%), hyperlipidemia (20.9 vs.14.8%) and prior CVD (7.5 vs.5.0%)]; while young woman had more depression (9.3 vs.5.9%) and cancer (4.1 vs.2.5%). The care access and management did not differ across groups, while those <40yrs old had significantly higher frequency of in-hospital seizure (6.5 vs 3.5%) and longer hospital stay than their older counterparts. At one year follow up 20.3% died or had another vascular event, while 10% had recurrent stroke. One-year mortality rate was lower in <40yrs old [adjusted HR=0.56, 95%CI (0.39 -0.86)]

Conclusion: The overall frequency of risk factors among young IS adults was low and the severity of stroke was mild. One-year mortality was higher than expected. These findings provide a platform for a prospective multi-center national study aiming to establish novel mechanism and prognosis of IS in the young in Canada.

Outcomes in Young Adults with Ischemic Stroke in Ontario