🟠 Moderate Evidence
Stroke incidence among adults under 55 years in England has risen significantly during and after the COVID-19 pandemic, according to a population-based study published in PLOS Medicine. The increase persisted even as pandemic restrictions eased, raising urgent questions about underlying drivers in younger populations.
Key takeaways
- Stroke incidence in adults under 55 rose 7% during 2020–2022 and continued rising 4% through 2024, according to data from 643,885 incident strokes in England
- Black and Asian ethnic minorities experienced disproportionately higher increases (13% and 26%, respectively)
- Diagnosis and management of key stroke risk factors (hypertension, diabetes, atrial fibrillation) showed mixed patterns across the study period
Study at a Glance
| Source | PLOS Medicine |
| Study type | Population-based record-linkage cohort study |
| Sample size | 643,885 incident strokes (2018–2024) |
| Population | English adults with first-ever stroke events |
| Country | England |
Young Adult Stroke Incidence Trends in England, 2018–2024
Age-standardised stroke incidence rate ratio by time period and ethnic group (index: 2018–2020 = 1.0)
Source: Kamtchum-Tatuene et al., PLOS Medicine, 2024 | Georgian Medical Journal News
Pandemic Acceleration, Post-Pandemic Persistence
Researchers led by Dr. Joseph Kamtchum-Tatuene at the University of Edinburgh analysed records from England’s primary care, hospital admissions, death certificates, and the national stroke audit between April 2018 and March 2024. The team identified 643,885 first-ever stroke events and tracked incidence across three distinct periods: pre-pandemic (2018–2020), pandemic (2020–2022), and post-pandemic (2022–2024).
The most striking finding: strokes in adults under 55 did not decline with pandemic recovery as might be expected. During 2020–2022, incidence rose 7% relative to the pre-pandemic baseline (incidence rate ratio [IRR] = 1.07, 95% confidence interval [CI] [1.05, 1.09], p < 0.001), according to the PLOS Medicine report. After restrictions eased (2022–2024), the upward trajectory continued, with a 4% further increase (IRR = 1.04, 95% CI [1.02, 1.06], p < 0.001).
This rising trend appeared consistent across sex, deprivation quintiles, geographic regions, and stroke subtypes. However, ethnic minorities bore a disproportionate burden, with documented health equity disparities emerging starkly in this dataset. Black adults under 55 experienced a 13% increase during 2020–2022 (IRR = 1.13, 95% CI [1.05, 1.21], p = 0.0005), while Asian adults faced a 26% increase (IRR = 1.26, 95% CI [1.20, 1.33], p < 0.001).
Risk Factor Diagnosis and Control: A Mixed Picture
The study also quantified diagnosis and pre-stroke treatment of four major modifiable risk factors: hypertension, diabetes, atrial fibrillation, and hyperlipidaemia. The researchers found that diagnosis rates for these conditions before stroke varied across the study periods, though complete results were not detailed in the published summary.
This gap raises a critical question: whether under-recognition, under-treatment, or new-onset disease accounts for the rise. A separate analysis of clinical trial data on cardiovascular risk management may shed light on screening and medication adherence trends during pandemic-related healthcare disruption.
Implications for Prevention and Health System Readiness
The persistence of increased young-adult stroke incidence into 2024 suggests the rise is not solely attributable to acute pandemic stress or temporary service disruption. Possible drivers include delayed diagnosis of risk factors, lifestyle changes sustained after lockdowns, post-viral inflammatory sequelae, or undiagnosed thrombophilias—though the study does not directly test causation.
At age under 55 years, stroke incidence during the pandemic (2020–2022) rose 7% compared to pre-pandemic baseline, with even higher increases in Black (13%) and Asian (26%) populations.
— Dr. Joseph Kamtchum-Tatuene, University of Edinburgh (PLOS Medicine, 2024)
What this means
Frequently asked questions
Why is stroke rising in younger people when overall stroke rates are falling?
The study shows stroke incidence at age ≥55 has been declining over the same period—a phenomenon called age-divergence. Younger adults may face emerging risk factors (psychological stress, sedentary behaviour, delayed diagnosis of hypertension or atrial fibrillation) not yet fully characterised. Post-viral inflammatory states are also being investigated in younger stroke cohorts.
Is this rise unique to England?
This dataset covers England only. Similar trends have been reported anecdotally in other high-income countries, but the PLOS Medicine study does not include international comparisons. Replication studies in other nations would help determine whether this is a global phenomenon or England-specific.
What should I do if I am under 55 and concerned about stroke risk?
Know your blood pressure, blood glucose, and cholesterol levels. If you have hypertension, diabetes, or atrial fibrillation, ensure you are on guideline-directed medical therapy. Stop smoking, limit alcohol, eat a heart-healthy diet, and exercise regularly. Seek urgent care if you experience sudden facial drooping, arm weakness, or speech difficulty—classic stroke warning signs.
The findings add to growing evidence that the pandemic and post-pandemic era have reshaped cardiovascular disease patterns in younger populations. The CVD-COVID-UK/COVID-IMPACT Consortium, which conducted this study, is expected to release further detailed analyses of risk factor management and healthcare access over coming months. Until then, clinicians and public health authorities should treat this signal as a catalyst for enhanced surveillance, targeted prevention, and equity-focused care redesign.
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