title: Trends in risk of recurrence after the first ischemic stroke in adults younger than 55 years of age in Sweden.
abstract: BACKGROUND
  Previous studies on stroke recurrence in younger adults often contain small sample size which makes it difficult to study trends in stroke recurrence over a long period of time.
  
  
  OBJECTIVE
  The aim of the present study was to investigate temporal trends in the risk of recurrence in younger patients with a first ischemic stroke.
  
  
  METHODS
  All men and women aged 18-54 years who had survived at least 28 days after a first ischemic stroke from 1987 to 2006 were identified in the Swedish Inpatient Register. The patients were stratified into four 5-year periods according to their admission period and were followed up for a total of four years after the index event with regard to recurrent ischemic stroke. A Cox regression model was used to analyze the risk of recurrent ischemic stroke.
  
  
  RESULTS
  Of the 17,149 ischemic stroke patients who were identified, 2432 (14.2%) had a recurrent ischemic stroke event within four years. From the first to the last periods (1987-1991 versus 2002-2006), the four-year risk of recurrent ischemic stroke decreased by 55% (hazard ratio 0.45, 95% confidence interval 0.39-0.53) in men and 59% (hazard ratio 0.41, 95% confidence interval, 0.33-0.50) in women. The cumulative four-year risk was 11.8% (95% CI 10.55-13.25) in men and 9.8% (95% CI 8.40-11.46) in women during the last five-year period (2002-2006).
  
  
  CONCLUSIONS
  The risk of recurrence among younger ischemic stroke patients has decreased over the past 20 years. Despite these improvements, younger patients are still at a high risk for recurrent ischemic stroke.
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden wai.giang.kok@gu.se.
authors.forename: Kok Wai
authors.initials: KW
authors.lastname: Giang
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Björck
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Christina H
authors.initials: CH
authors.lastname: Ståhl
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Susanne
authors.initials: S
authors.lastname: Nielsen
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Tatiana Z
authors.initials: TZ
authors.lastname: Sandström
authors.affiliation: Department of Clinical Neurosciences and Rehabilitation, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Jern
authors.affiliation: Section of Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Kjell
authors.initials: K
authors.lastname: Torén
authors.affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
mesh_terms: D000293:Adolescent; D000328:Adult; D002545:Brain Ischemia / Q000453:epidemiology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D012306:Risk; D020521:Stroke / Q000453:epidemiology*; D013548:Sweden; D055815:Young Adult
keywords: Epidemiology; ischemic stroke; recurrent stroke; stroke; temporal trend; younger age