Abstract P342: Disparities in Awareness of Stroke Symptoms Among Different Socioeconomic, Ethnic/Race, and At-risk-of-stroke Groups

Findings from a few small studies suggested that disparities in awareness of stroke symptoms lead to disparities in delays of receiving treatment and outcomes of patients with stroke. Hence it is important to conduct a study with a large sample size to understand the associations between awareness of symptoms of stroke with various socioeconomic factors as well as with modifiable stroke risk factors. We assessed the hypotheses that there are disparities in awareness of different stroke symptoms among different groups with respect to various SES factors (e.g., self-reported race, ethnicity, education, age, and income) in the presence/absence of modifiable stroke risk factors (e.g., smoking status, exercise, body mass index, and blood pressure). We combined four Behavioral Risk Factor Surveillance Surveys (BRFSS) from 2003, 2005, 2007, and 2009 to create a sample of 1,051,834 participants. We ran six logistic regression models, one for each of the measures of awareness of six common stroke symptoms (e.g., sudden confusion, numbness on one side of the body, sudden vision loss, sudden chest pain, sudden dizziness, and severe unexplained headache). The unweighted sample size in each of the six models was greater than 120,000. In addition, we calculated marginal probabilities which give the probability of an outcome (e.g., being aware of a specific stroke symptom) with respect to a specific factor (e.g., in the presence/absence of a stroke risk factor) in the context of averaging over all other factors/covariates. While there was low awareness of stroke symptoms among the US population except for recognition of chest pain or discomfort, we did find an association between the awareness of stroke symptoms with gender, educational levels, and income levels. Additionally, among all the ethnic groups, Native Americans had the lowest awareness of five out of six stroke symptoms. On the other hand, White only-non Hispanic, while being relatively better aware of several stroke symptoms, had the lowest awareness of the most common stroke symptom of sudden chest pain compared with other race/ethnicity groups. In conclusion, the findings from this study can serve as a useful guide to facilitating targeted educational efforts aimed at improving awareness of stroke symptoms that may ultimately reduce disparities in the outcomes of patients at risk for stroke.

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Abstract WP224: Impact of Stroke Risk Factors on Ethnic Stroke Disparities Among Midlife Mexican Americans and Non-hispanic Whites

Stroke ◽

10.1161/str.48.suppl_1.wp224 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Rajiv C Patel ◽

Brisa Sanchez ◽

Lewis Morgenstern ◽

Chengwei Li ◽

Lynda Lisabeth

Keyword(s):

Risk Factors ◽

High School ◽

At Risk ◽

Risk Factor ◽

Health Insurance ◽

Mexican Americans ◽

Stroke Risk ◽

Census Data ◽

Population At Risk ◽

Stroke Risk Factors

Introduction: Overall ischemic stroke (IS) incidence has declined in the US, but has remained stable among midlife (age 45-59) adults and is higher in midlife Mexican Americans (MAs). We examined the contribution of stroke risk factors to ethnic differences in IS rates among midlife MAs and non-Hispanic Whites (NHWs) in a population-based study. Methods: Incident IS (N=823) counts and corresponding risk factors were identified from the BASIC Project, Nueces County, Texas (2000-2010). US Census data (2000) for Nueces County was used to estimate the population at-risk for stroke, and the Texas Behavioral Risk Factor Surveillance System for Public Health Region 11(2000-2010) was used to estimate prevalence of risk factors in the stroke free population. Poisson regressions were run combining stroke counts (numerator) and population at-risk counts (denominator) classified by ethnicity and risk factor status to estimate unadjusted and risk factor adjusted associations between ethnicity and IS rates. Separate models were run for each risk factor (diabetes, hypertension, coronary heart disease, high cholesterol, education < high school, no health insurance, current smoking, BMI>30), and extended to include an interaction term between ethnicity and risk factor. Results: The crude ethnic IS rate ratio (RR) comparing MAs with NHWs was 2.13 (95% CI: 1.84-2.47). The ethnic RR was lower in models that adjusted for diabetes (RR:1.54; 95% CI: 1.31-1.78), hypertension (RR: 1.92; 95% CI: 1.65-2.22), and education < high school (RR: 2.02; 95% CI: 1.72-2.38) compared to the crude association. Ethnicity significantly modified associations between diabetes, smoking, health insurance, education and IS rates. Associations between diabetes and IS rates was greater among MAs (RR: 6.82, 95% CI: 5.76-8.07) compared with NHWs (RR: 4.40, 95% CI: 3.33-5.81), while smoking associations were greater in NHWs (MA RR: 2.61, 95% CI: 2.20-3.10; NHW RR: 3.49, 95% CI: 2.73-4.46). Socioeconomic variables increased IS risk in NHWs but were insignificant or protective in MAs. Conclusion: Traditional stroke risk factors may contribute to midlife ethnic stroke disparities; particularly diabetes, given its high prevalence and stronger association with IS among midlife MAs as compared with NHWs.

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Public health campaigns and their effect on stroke knowledge in a high-risk urban population: A five-year study

Vascular ◽

10.1177/1708538117691879 ◽

2017 ◽

Vol 25 (5) ◽

pp. 497-503 ◽

Cited By ~ 5

Author(s):

Maged M Metias ◽

Naomi Eisenberg ◽

Michael D Clemente ◽

Elizabeth M Wooster ◽

Andrew D Dueck ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

High Risk ◽

Stroke Risk ◽

High Risk Population ◽

Stroke Risk Factor ◽

Stroke Risk Factors ◽

Awareness Campaigns ◽

Stroke Symptom ◽

Stroke Knowledge

Background The level of knowledge of stroke risk factors and stroke symptoms within a population may determine their ability to recognize and ultimately react to a stroke. Independent agencies have addressed this through extensive awareness campaigns. The aim of this study was to determine the change in baseline knowledge of stroke risk factors, symptoms, and source of stroke knowledge in a high-risk Toronto population between 2010 and 2015. Methods Questionnaires were distributed to adults presenting to cardiovascular clinics at the University of Toronto in Toronto, Canada. In 2010 and 2015, a total of 207 and 818 individuals, respectively, participated in the study. Participants were identified as stroke literate if they identified (1) at least one stroke risk factor and (2) at least one stroke symptom. Results A total of 198 (95.6%) and 791 (96.7%) participants, respectively, completed the questionnaire in 2010 and 2015. The most frequently identified risk factors for stroke in 2010 and 2015 were, respectively, smoking (58.1%) and hypertension (49.0%). The most common stroke symptom identified was trouble speaking (56.6%) in 2010 and weakness, numbness or paralysis (67.1%) in 2015. Approximately equal percentages of respondents were able to identify ≥1 risk factor (80.3% vs. 83.1%, p = 0.34) and ≥1 symptom (90.9% vs. 88.7%, p = 0.38). Overall, the proportion of respondents who were able to correctly list ≥1 stroke risk factors and stroke symptoms was similar in both groups.(76.8% vs. 75.5%, p = 0.70). The most commonly reported stroke information resource was television (61.1% vs. 67.6%, p = 0.09). Conclusion Stroke literacy has remained stable in this selected high-risk population despite large investments in public campaigns over recent years. However, the baseline remains high over the study period. Evaluation of previous campaigns and development of targeted advertisements using more commonly used media sources offer opportunities to enhance education.

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Abstract TP172: Analysis of Stroke Risk and Risk Factor Awareness in Samoa

Stroke ◽

10.1161/str.44.suppl_1.atp172 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Lydia A Trupe ◽

Viali Lameko

Keyword(s):

Risk Factors ◽

At Risk ◽

Risk Factor ◽

High Risk ◽

Stroke Risk ◽

Warning Signs ◽

Low Risk ◽

Hospital Inpatient ◽

Stroke Risk Factors ◽

The Impact

Background: The prevalence of stroke in Samoa is extremely high due to high rates of risk factors such as obesity, hypertension, and diabetes. Stroke remains the leading cause of death in Samoa. We hypothesized that poor knowledge of stroke risk factors and warning signs contributes to high stroke prevalence in Samoa, such that widespread dissemination of information might induce lifestyle changes (e.g. diet and exercise) and cause more people to seek treatment for stroke. Methods: We enrolled a series of English-speaking Samoan adults age 25- 65 (mean=45) on the Tupua Tamasese Meaole Hospital inpatient service from January to April, 2012. Because they were inpatients, they tended to be at a higher stroke risk than the general population. Detailed interviews were conducted regarding knowledge of stroke risk factors and warning signs and assessment of personal stroke risk. Participants’ cerebrovascular risk was categorized as high, moderate or low based on their risk factors. Participants were informed of their stroke risk, ways to reduce stroke risk, warning signs and what to do in the event of stroke. Results: Of 19 adults interviewed, 8 were categorized as “high risk”, 3 as “moderate risk” and 8 as “low risk.” Participants were able to name a mean of 0.74 risk factors for stroke and mean of 1.2 warning signs. 21% incorrectly named stress as a common risk factor. The most common risk factors correctly named were obesity/unhealthy diet (23.8%) and diabetes (15.8%). There was no association between stroke risk classification and participant’s belief that they were at risk of stroke (chi square=1.6; ns); 50% of high-risk participants and 25% of low risk patients believed they were at risk of having a stroke. High-risk participants, compared to low-risk participants, had a slightly higher knowledge of both stroke risk factors (mean=1 vs. 0.25) and warning signs (2 vs. 0.63). Conclusion: In Samoa, knowledge of stroke risk factors and warning signs is very low. It is likely that many Samoans receive health information after developing medical conditions; thus, high-risk individuals tend to have slightly higher knowledge. We aim to conduct a larger study with follow-up interviews to determine the impact of education.

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947. Stroke demographics and risk factor profile in HIV infected individuals in Florida

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1133 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S506-S506

Author(s):

Folusakin Ayoade ◽

Dushyantha Jayaweera

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Clinical Research ◽

Stroke Risk ◽

Research Network ◽

Categorical Variables ◽

People Living With Hiv ◽

Risk Factor Profile ◽

Stroke Risk Factors ◽

Living With Hiv

Abstract Background The risk of ischemic stroke (IS) is known to be higher in people living with HIV (PLWH) than uninfected controls. However, information about the demographics and risk factors for hemorrhagic stroke (HS) in PLWH is scant. Specifically, very little is known about the differences in the stroke risk factors between HS and IS in PLWH. The goal of this study was to determine the demographics and risk factor differences between HS and IS in PLWH. Methods We retrospectively analyzed the demographic and clinical data of PLWH in OneFlorida (1FL) Clinical Research Consortium from October 2015 to December 2018. 1FL is a large statewide clinical research network and database which contains health information of over 15 million patients, 1240 clinical practices, and 22 hospitals. We compared HS and IS based on documented ICD 9 and 10 diagnostic codes and extracted information about sociodemographic data, traditional stroke risk factors, Charlson comorbidity scores, habits, HIV factors, diagnostic modalities and medications. Statistical significance was determined using 2-sample T-test for continuous variables and adjusted Pearson chi square for categorical variables. Odds ratio (OR) and 95% confidence intervals (CI) between groups were compared. Results Overall, from 1FL sample of 13986 people living with HIV, 574 subjects had strokes during the study period. The rate of any stroke was 18.2/1000 person-years (PYRS). The rate of IS was 10.8/1000 PYRS while the rate of HS was 3.7/1000 PYRS, corresponding to 25.4% HS of all strokes in the study. Table 1 summarizes the pertinent demographic and risk factors for HS and IS in PLWH in the study. Table 1: Summary of pertinent demographic and risk factors for hemorrhagic and ischemic strokes in people living with HIV from One Florida database Conclusion In this large Floridian health database, demographics and risk factor profile differs between HS and IS in PLWH. Younger age group is associated with HS than IS. However, hypertension, hyperlipidemia and coronary artery disease are more likely to contribute to IS than HS in PLWH. Further research is needed to better understand the interplay between known and yet unidentified risk factors that may be contributing to HS and IS in PLWH. Disclosures All Authors: No reported disclosures

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Abstract T P136: Potential Contributors to the Declining Impact of Stroke Risk Factors with Age: Implications for Stroke Epidemiology in the Elderly

Stroke ◽

10.1161/str.45.suppl_1.tp136 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

George Howard ◽

Mary Cushman ◽

Maciej Banach ◽

Brett M Kissela ◽

David C Goff ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Multivariable Analysis ◽

The Elderly ◽

Stroke Risk Factors ◽

Age Related ◽

Increased Risk ◽

The Impact ◽

Age Related Changes

Purpose: The importance of stroke research in the elderly is increasing as America is “graying.” For most risk factors for most diseases (including stroke), the magnitude of association with incident events decreases at older ages. Potential changes in the impact of risk factors could be a “true” effect, or could be due to methodological issues such as age-related changes in residual confounding. Methods: REGARDS followed 27,748 stroke-free participants age 45 and over for an average of 5.3 years, during which 715 incident strokes occurred. The association of the “Framingham” risk factors (hypertension [HTN], diabetes, smoking, AFib, LVH and heart disease) with incident stroke risk was assessed in age strata of 45-64 (Young), 65-74 (Middle), and 75+ (Old). For those with and without an “index” risk factor (e.g., HTN), the average number of “other” risk factors was calculated. Results: With the exception of AFib, there was a monotonic decrease in the magnitude of the impact across the age strata, with HTN, diabetes, smoking and LVH even becoming non-significant in the elderly (Figure 1). However, for most factors, the increasing prevalence of other risk factors with age impacts primarily those with the index risk factor absent (Figure 2, example HTN as the “index” risk factor). Discussion: The impact of stroke risk factors substantially declined at older ages. However, this decrease is partially attributable to increases in the prevalence of other risk factors among those without the index risk factor, as there was little change in the prevalence of other risk factors in those with the index risk factor. Hence, the impact of the index risk factor is attenuated by increased risk in the comparison group. If this phenomenon is active with latent risk factors, estimates from multivariable analysis will also decrease with age. A deeper understanding of age-related changes in the impact of risk factors is needed.

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Abstract P602: Stroke Risk Factors Among the Young Over Time in the GCNKSS

Stroke ◽

10.1161/str.52.suppl_1.p602 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Tracy E Madsen ◽

Jane C Khoury ◽

Kathleen S Alwell ◽

Opeolu M Adeoye ◽

Felipe De Los Rios La Rosa ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Large Population ◽

High Cholesterol ◽

Stroke Incidence ◽

Stroke Risk Factors ◽

Obesity And Diabetes ◽

Trends Over Time ◽

Over Time

Background: Data from the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS) have demonstrated stable or increasing stroke incidence rates in young adults with differences by sex and race, suggesting the need for targeted approaches to stroke prevention in the young. We aimed to describe trends over time in prevalence of stroke risk factors among adults ages 20-54 with stroke by sex and race. Methods: Cases of incident stroke (IS, ICH, SAH) occurring in those 20-54 years old and living in a 5-county area of southern Ohio/northern Kentucky were ascertained during 5 study periods (1993-1994, 1999, 2005, 2010, 2015). All physician-adjudicated inpatient events and a sampling of outpatient events were included, excluding nursing home events. Data on risk factors (hypertension, diabetes, obesity (BMI≥30), and high cholesterol) diagnosed prior to stroke were abstracted from medical records, and prevalence of each risk factor was reported over time in race/sex groups. Trends over time were examined using the Cochran-Armitage test. Results: Over the 5 study periods, 1204 incident strokes were included; 49% were women, 33% were black, and mean age was 46 (SD 7) years. Premorbid hypertension increased over time in Black women (48% in 1993/4 to 76% in 2015, p=0.005) but not in any other race/sex group (all p>0.05). Premorbid high cholesterol increased significantly in all race/sex groups (Figure, all p<0.05) except for White men (p=0.06). There were no significant trends over time in pre-stroke diagnoses of diabetes or obesity in any of the race/sex groups (Figure). Conclusions: Among patients aged 20-54 with incident stroke in a large population-based study, the change in the prevalence of hypertension and high cholesterol differed by sex and race, while obesity and diabetes were stable over time in all race/sex groups. Future research is needed to address risk factor control at a population level and to understand the role of undiagnosed pre-stroke risk factors in the young.

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Abstract NS6: Family History of Stroke: Invisibility of a Key Stroke Risk Factor among High Risk African Americans

Stroke ◽

10.1161/str.44.suppl_1.ans6 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Dawn M Aycock ◽

Kenya D Kirkendoll ◽

Kisha C Coleman ◽

Karen C Albright ◽

Anne W Alexandrov

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Family History ◽

Perceived Control ◽

Stroke Risk ◽

Perceived Threat ◽

Stroke Risk Factor ◽

Stroke Risk Factors ◽

History Of ◽

Physiologic Data

Background & Purpose: Young to middle aged African Americans (AA) are at greater risk for a first-ever stroke, severe neurologic disability, and stroke-related mortality, than Caucasians of similar age; however, it remains unclear what role a family history of stroke (FHS) plays in promoting adoption of healthier lifestyles in this cohort. The purpose of this study was to explore differences between rural Stroke Belt AA with a FHS (e.g. parent/grandparent/sibling) on modifiable stroke risk factors, knowledge, perceived threat and perceived control of stroke, and exercise behaviors to AA without a FHS. Methods: A cross-sectional study was conducted recruiting AA aged 19-54 from the Black Belt region of Alabama via a mobile health clinic. Participants’ perceptions, knowledge, exercise history/intent, physiologic data, and health history were recorded. Results: Participants (N=66) averaged 43.3+9.4 years, were 71% female, with at least 12 years of school (89%), and unemployed (62%). Common risk factors were insufficient exercise (76%), obesity (59%), hypertension (53%; blood pressure M=145+17.6/88.3+12.9), and cigarette smoking (38%). Participants with a FHS (n=33) did not differ on average number of risk factors compared to those without a FHS (FHS 2.8+1.4 vs. 2.2+1.5; t(64)= 1.73, p=.089), nor did they differ on physiologic data. However, participants with a FHS were more likely to report a history of hypertension (67%) compared to those without a FHS (33%; χ2 =4.93, p <.05). There were no significant differences between groups for knowledge of stroke risk factors, perceived threat and perceived control of stroke, or recent exercise performance, although participants with a FHS (3.4+1.2) had significantly lower future intentions to exercise compared to those without a FHS (3.9+0.8); t(64)=2.45, p<.05). Conclusions: Although FHS is a significant non-modifiable risk factor for stroke and was common in this young to middle-aged AA cohort, FHS did not drive perceived stroke risk, risk factor control, or current/future intentions to exercise. Identification of interventions designed to personalize FHS as a key stroke risk factor, while promoting lifestyle change and self-management, may play an important role in future primary stroke prevention.

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Abstract TP203: Reducing Stroke Burden in Uganda

Stroke ◽

10.1161/str.48.suppl_1.tp203 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Mark Kaddumukasa ◽

Jane Nakibuuka ◽

James Kayima ◽

Elly Katabira ◽

Carol Blixen ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Growth Patterns ◽

Warning Signs ◽

Clear Understanding ◽

Stroke Risk Factor ◽

Stroke Risk Factors ◽

Study Participants ◽

Stroke Knowledge

Background: Stroke is a neurological condition with rapidly increasing burden in many low- and middle-income countries. Africa is particularly hard-hit due to rapid population growth, patterns of industrialization, adoption of harmful western diets, and increased prevalence of risk factors such as hypertension and obesity. Reducing stroke risk factors and teaching people to respond to stroke warning signs can prevent stroke and reduce burden. However, being able to address gaps in knowledge and improving both preventative and early-response care requires a clear understanding of practical and potentially modifiable topics. Methods: A cross sectional survey was conducted in urban Mukono district in central Uganda. Through a systematic sampling method, data were gathered from 440 adult participants who were interviewed about selected aspects of stroke knowledge, attitudes and perception, using a pretested structured questionnaire. Results: Of the 440 study participants enrolled for this study nearly 52% correctly reported that stroke involves the brain, while 57% reported that stroke is preventable. Majority of the participants 75.7% reported stress as a contributing factor. Only 45.7% of the study participants reported hypertension as a risk factor. Only two (0.5%) study participants identified cigarette smoking as a stroke risk factor. Of the eighty six study participants with hypertension only 39.5% knew hypertension as a risk factor and only 10.7% knew three or more stroke risk factors. Conclusion: Stroke knowledge is poor in urban Uganda. Individuals with hypertension had poor knowledge regarding stroke in spite their high risk for stroke. Stress and hypertension are the leading perceived risk factors in our settings. While stress is highly reported as a stroke risk factor in this study hypertension is likely a more amenable and practical intervention target.

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Non-valvular atrial fibrillation patients with none or one additional risk factor of the CHA2DS2-VASc score

Thrombosis and Haemostasis ◽

10.1160/th15-07-0565 ◽

2015 ◽

Vol 114 (10) ◽

pp. 826-834 ◽

Cited By ~ 70

Author(s):

Flemming Skjøth ◽

Peter Nielsen ◽

Torben Bjerregaard Larsen ◽

Gregory Lip

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Additional Risk Factor ◽

Stroke Risk Factor ◽

Stroke Risk Factors ◽

Long Run ◽

One Year ◽

Net Clinical Benefit

SummaryOral anticoagulation (OAC) to prevent stroke has to be balanced against the potential harm of serious bleeding, especially intracranial haemorrhage (ICH). We determined the net clinical benefit (NCB) balancing effectiveness and safety of no antithrombotic therapy, aspirin and warfarin in AF patients with none or one stroke risk factor. Using Danish registries, we determined NCB using various definitions intrinsic to our cohort (Danish weights at 1 and 5 year follow-up), with risk weights which were derived from the hazard ratio (HR) of death following an event, relative to HR of death after ischaemic stroke. When aspirin was compared to no treatment, NCB was neutral or negative for both risk strata. For warfarin vs no treatment, NCB using Danish weights was neutral where no risk factors were present and using five years follow-up. For one stroke risk factor, NCB was positive for warfarin vs no treatment, for one year and five year follow-up. For warfarin vs aspirin use in patients with no risk factors, NCB was positive with one year follow-up, but neutral with five year follow-up. With one risk factor, NCB was generally positive for warfarin vs aspirin. In conclusion, we show a positive overall advantage (i.e. positive NCB) of effective stroke prevention with OAC, compared to no therapy or aspirin with one additional stroke risk factor, using Danish weights. ‘Low risk’ AF patients with no additional stroke risk factors (i.e. CHA2DS2-VASc 0 in males, 1 in females) do not derive any advantage (neutral or negative NCB) with aspirin, nor with warfarin therapy in the long run.Note: The review process for this manuscript was fully handled by Christian Weber, Editor in Chief.

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Trends of risk profile among middle-aged adults hospitalized for acute ischemic stroke in United States 2006–2017

International Journal of Stroke ◽

10.1177/1747493020979379 ◽

2020 ◽

pp. 174749302097937

Author(s):

Xin Tong ◽

Quanhe Yang ◽

Mary G George ◽

Cathleen Gillespie ◽

Robert K Merritt

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Risk ◽

Stroke Patients ◽

Stroke Risk Factors ◽

Percent Change ◽

Lipid Disorders ◽

Major Stroke

Background Recent studies reported increasing trends in hospitalization of stroke patients aged 35–64 years. Aim To examine changes in risk factor profiles among patients aged 35–64 years hospitalized with acute ischemic stroke between 2006 and 2017 in the United States. Methods We used data from the National Inpatient Sample of the Healthcare Cost and Utilization Project from 2006 through 2017. Principal ICD-9-CM/ICD-10-CM codes were used to identify acute ischemic stroke hospitalizations, and secondary codes were used to identify the presence of four major stroke risk factors: hypertension, diabetes, lipid disorders, and tobacco use. We used the relative percent change to assess the changes in the prevalence of risk profile between 2006–2007 and 2016–2017 and linear regression models to obtain the p values for the overall trends across six time periods. Results Approximately 1.5 million acute ischemic stroke hospitalizations occurred during 2006–2017. The prevalence of having all four risk factors increased from 4.1% in 2006–2007 to 9.1% in 2016–2017 (relative percent change 122.0%, p < 0.001 for trend), prevalence of any three risk factors increased from 24.5% to 33.8% (relative percent change 38.0%, p < 0.001). Prevalence of only two risk factors decreased from 36.1% to 32.7% (p < 0.001), only one risk factor decreased from 25.2% to 18.1% (p < 0.001), and absence of risk factors decreased from 10.1% to 6.2% (p < 0.001). The most prevalent triad of risk factors was hypertension, diabetes, and lipid disorders (14.3% in 2006–2007 and 19.8% in 2016–2017), and the most common dyad risk factors was hypertension and lipid disorders (12.6% in 2006–2007 and 11.9% in 2016–2017). Conclusions The prevalence of hospitalized acute ischemic stroke patients aged 35–64 years with all four or any three of four major stroke risk factors increased by 122% and 38%, while those with only one risk factor or no risk factor has declined by 28% and 39%, respectively, from 2006 to 2017. Younger adults are increasingly at higher risk for stroke from preventable and treatable risk factors. This growing public health problem will require clinicians, healthcare systems, and public health efforts to implement more effective prevention strategies among this population.

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