Sex-Specific Trends and Differences in Clinical Outcomes Among Young Patients With Ischemic Stroke

Abstract

Stroke in young adults poses significant public health challenges, with an increasing incidence globally. This study examines sex-specific trends, clinical outcomes, and healthcare resource utilization in young adults with ischemic stroke in the United States. Using the National Inpatient Sample from 2016 to 2021, we identified ischemic stroke hospitalizations in adults aged 18 to 44 years. We compared baseline characteristics, comorbidities, and outcomes between sexes, assessing trends with weighted regression and multivariate logistic regression to adjust for confounders; 168 310 hospitalizations were analyzed: 86 705 (51.5%) men and 81 605 (48.5%) women. Men had a higher prevalence of cardiovascular comorbidities, including hypertension, hyperlipidemia, and smoking while women had higher rates of diabetes, hypothyroidism, and anemia. Women had a lower adjusted odds ratio (aOR) for mortality (0.84, 95% CI: 0.75-0.94, P = .001) and acute kidney injury (0.50, 95% CI: 0.47-0.54, P < .001). The incidence of ischemic stroke/100 000 hospitalizations increased steadily over 6 years for both sexes, though men consistently showed higher rates. This study highlights sex-specific differences in ischemic stroke among young adults, with women showing better outcomes despite unique risk profiles. Targeted interventions addressing modifiable risk factors are needed to reduce stroke burden, particularly in young men.