A comparison of stroke in young and older adults admitted at MUHAS academic medical centre in Tanzania

Abstract

ABSTRACT Background: Current epidemiological evidence indicates a global rise in stroke burden among young adults mainly attributed to unique risk factors inherent to genetics and the environment. The outcomes of stroke in young adults is devastating associated with substantial morbidity and fatality jeopardizing their prime time. Furthermore, there is paucity of data on the prevalence, risk factors and 30-day outcomes of stroke among young adults in Tanzania. Aim: To determine the prevalence of first ever stroke, describe stroke sub types, risk factors and 30 day outcomes in young adults (≤45 years) compared to older adults (>45 years). Methodology: This cohort study consecutively recruited 369 consented first ever stroke participants (123 young vs 246 older adults) admitted at Muhas Academic Medical Center with a World Health Organization clinical criteria for stroke. Demographics, stroke sub type and stroke risk factors were captured. Stroke severity was assessed using the National Institute of Health Stroke Scale. Each participant was followed up at 24 hours, 72 hours, 7 days, 14 days to 30 days for outcomes using the Modified Rankin Scale. Stroke prevalence and risk factors in the young were compared to old adults. Kaplan Meier analysis was used to estimate 30-day survival in young and old. Results: The prevalence of stroke in young adults was 25.4% (95% CI 21.5% - 29.3%) and in older adults 26.8% (95% CI 23.9% - 29.6%). Hemorrhagic stroke occurred in 42.3% among the young vs 27.2% in older adults p=0.005. Factors associated with stroke in the young compared to the old were: a new diagnosis of hypertension at hospital admission 26.8% vs 9.3% p<0.001, HIV infection 11.4% vs 4.9% p=0.021, use of illicit drugs 4.1% vs 0.8% p=0.044, hormonal contraception 48.5% vs 9.4% p<0.001, mitral stenosis 3.3% vs 0% p=0.012, Hypercholesteremia 31.2% vs 20.2% p=0.031 and sickle cell disease 9.7% vs 4.2% p=0.047. Majority of the participants had severe stroke and at 30 days the fatality rates were 49.1% in young vs 67.2% in older adults. Conclusion and Recommendation: The high burden of stroke in young is coupled with very high 30-day fatality rates. Young strokes have special risk factors that should be screened and controlled so as to prevent subsequent development of stroke. There is an urgent need of integrating preventive strategies to combat stroke in young adults.