The burden and outcome of stroke in young adults in a Tanzanian Tertiary Hospital: A Comparison with older Adults

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Abstract Background: Stroke burden in young adults is growing and is associated with unique risk factors and devastating outcomes. We aimed at describing the magnitude, risk factors and outcomes of first ever stroke in young adults ≤45 years compared to older adults >45 years. Methods: Participants were patients admitted with World Health Organization clinical criteria for stroke at a tertiary hospital in Tanzania. The National Institute of Health Stroke Scale and Modified Rankin Scale were used to assess for stroke severity and outcomes respectively. Kaplan-Meier analysis was used to estimate for survival. Results: We enrolled 369 first ever stroke participants out of 1403 medical admissions over 8 months’ duration. The overall stroke prevalence was 369 (26.3%) and was 123/484 {(25.4%) [95% CI 21.5% - 29.3%]} and 246/919 {(26.8%) [95% CI 23.9% - 29.6%]} for young and old 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 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 median time for seeking health care was 2 days from stroke symptom onset. The overall 30-day fatality rate was 215 (61.3%) and 57 (49.1%) vs 158 (67.2%) in the young and old respectively. Conclusions: There is a high prevalence of stroke in young adults that is coupled with a high 30day fatality rate. Screening and treatment of hypertension is key in prevention of stroke in the young.

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