According to the medical bills submitted to the Haigekassa in 2021, there were 3,351 cases of stroke requiring emergency hospital treatment. To understand the patterns over the past several decades, Estonian researchers analyzed the incidence of stroke in the Tartu community. They discovered that, since the early 1990s, the incidence of stroke among youths, particularly men, has declined.
"A large proportion of strokes cause disability," Liisa Kõrv, a neurologist at the North-Estonian Regional Hospital and a doctoral student at the University of Tartu, said. Despite the fact that younger people are more likely to experience milder strokes, many who suffer a stroke are disabled for years as a result. "Even when there is no apparent physical handicap, we may find cognitive dysfunction, depression, a higher risk of suicide, anxiety and increased mortality throughout the course of a person's lifespan," Kõrv explained.
Kõrv collaborated on a new study that looked at the prevalence of strokes among Tartu residents aged 15 to 54. The working group used self-reported data from 1991-1993, 2001-2003, and 2013-2017 to conduct a population-based analysis of in-hospital and out-of-hospital stroke incidents. According to the findings, the number of strokes decreased over time, with the greatest decline occurring in the 1990s.
Clear and hypothetical improvements
"In general, we could say that the situation in Estonia has improved," Kõrv said, referring to the number of strokes among younger population
She explained that the incidence of stroke in Estonia was high in comparison to other nations in the early 1990s.
"At the time, Estonia's socioeconomic condition was extremely precarious. There was a great deal of tension in society, as well as a high incidence of stroke."
Data from Tartu showed that there were 57.2 first-time strokes per 100,000 adults aged 15-54 per year in the early 1990s, but by 2013-2017, this number had dropped to 38.
"We can say that the decline occurred during the 1990s. There was no statistically significant difference in the overall incidence rate between our second and third survey periods," Kõrv added.
"The researchers also looked at the age and gender differences in first strokes.
When the trend was examined by gender, a comparable large decline was seen in the male population," Kõrv said. For women, the number of first strokes fell, but only in the 45-54 age range, explaining a significant decrease in the average age of women. At the same time, Kõrv said, during 2001-2003 and 2013-2017, the incidence rate for younger men aged 35 to 44 also decreased.
"Lower age groups did not show statistically significant changes. The situation has remained constant, which is not arguably a favorable development," Kõrv said. On the one hand, the incidence of stroke in the youngest age groups is so low that a statistically significant trend cannot be established. On the other hand, Kõrv and her co-workers hypothesized that the steady level in younger people indicates improvement.
"Is it not a matter of increased awareness and improved diagnostic tools? Is it possible that we have improved our ability to detect strokes?" the neurologist continued. So the real downward trend may simply be obscured by more frequent doctor visits. "I don't think the result directly implies anything negative, but perhaps we should look into this stable frequency among young people in more detail," Kõrv said.
Willing to ask for assistance
"We chose this topic because, while the incidence in older age groups has decreased dramatically in other parts of the world due to better management of risk factors, some studies report an increase in stroke instances among young people," Kõrv explained. Many of these studies, however, have used a methodology that specifically accounts for hospital admissions. As a result, increased awareness, according to Kõrv, leads to an increase in recorded incidents.
"We have a hunch that more strokes are being recorded now because more patients are visiting the doctor with milder symptoms," she explains.
"This awareness must be raised so that people are even more willing to seek help," she said. The more causes of stroke are discovered, the easier it will be to prevent future incidents.
Hypertension, high cholesterol levels, heart rhythm disorders, smoking, excessive alcohol use, obesity and diabetes are the most serious risk factors for stroke.
Although, Kõrv said, "the majority of these concerns are widespread among older people, but they are also growing more prevalent among youths."
"The most recognizable symptoms of a stroke are the sudden drooping of one of the mouth's corners, the arm going limp, and the onset of slurred speech," she explains. The neurologist advised anyone experiencing any of the symptoms to call an ambulance right away because treatment is time-sensitive. Don't be hesitant to call just in case, she said, "small children and infants can experience a stroke."
Editor: Kristina Kersa