Importance Some studies have reported increasing stroke incidence at younger ages (<55 years) but have often relied only on administrative data, and more population-based studies of adjudicated stroke are required. An understanding of the drivers of any increase in incidence of young stroke also requires comparisons with stroke trends at older ages and with trends in incidence of other vascular events at younger ages. Objective To determine temporal changes in incidence of stroke and other major vascular events at younger vs older ages. Design, Setting, and Participants Prospective population-based incidence study conducted from April 2002 to March 2018 with a mean catchment population of 94 567 in Oxfordshire, England. Exposures Calendar time, premorbid vascular risk factors, and occupation. Main Outcomes and Measures Changes in incidence of stroke, transient ischemic attack (TIA), and other major vascular events (myocardial infarction, sudden cardiac death, and peripheral vascular events) stratified by age, sex, diagnostic workup, etiology, and severity. Results A total of 2429 incident strokes were ascertained (mean age, 73.6 [SD, 14.4] years; 51.3% female). From 2002-2010 to 2010-2018, stroke incidence increased significantly among participants younger than 55 years (incidence rate ratio [IRR], 1.67; 95% CI, 1.31-2.14) but fell significantly among participants aged 55 years or older (IRR, 0.85; 95% CI, 0.78-0.92; P < .001 for difference). The significant increase in incidence at younger than 55 years was independent of sex, stroke severity, pathological subtype, and changes in investigation and was also seen for TIA (IRR, 1.87; 95% CI, 1.36-2.57) but not for myocardial infarction and other major vascular events (IRR, 0.73; 95% CI, 0.58-0.93). Although TIA and stroke at younger than 55 years were significantly associated with diabetes (risk ratio [RR], 3.47; 95% CI, 2.54-4.74), hypertension (RR, 2.52; 95% CI, 2.04-3.12), current smoking (RR, 2.38; 95% CI, 1.92-2.94), and obesity (RR, 1.36; 95% CI, 1.07-1.72), the significant increase in incidence from 2002-2010 to 2010-2018 was still seen in individuals without these risk factors. The increase was greatest in professional/managerial occupations (IRR, 2.52; 95% CI, 1.75-3.62) and least in partially skilled/unskilled occupations (IRR, 1.17; 95% CI, 0.79-1.74). The proportion of TIAs and strokes among those younger than 55 years without known vascular risk factors increased significantly over time (45 [30.4%] vs 115 [42.4%]; absolute difference, 12.0%; 95% CI, 2.6-21.5), especially in patients with cryptogenic events (10 [18.5%] vs 63 [49.2%]; absolute difference, 30.7%; 95% CI, 17.2-44.2; P < .001; P = .002 for heterogeneity). Conclusions and Relevance Comparing persons living in Oxfordshire, England, in 2002-2010 vs 2010-2018, there was a significant increase in stroke incidence in those younger than 55 years, but a decrease in those aged 55 years or older. Given the absence of this divergence for other vascular events, further research is needed to understand the causes of this difference.

中文翻译：

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2002-2018 年年轻与年长年龄与中风和其他血管事件发生率变化的关联。


重要性 一些研究报告，年轻人群（<55 岁）的中风发病率有所增加，但通常仅依赖于行政数据，因此需要对已判定的中风进行更多基于人群的研究。要了解年轻中风发病率增加的驱动因素，还需要与老年时的中风趋势以及年轻时其他血管事件的发生率趋势进行比较。目的 确定年轻与老年时中风和其他主要血管事件发生率的时间变化。设计、背景和参与者 2002 年 4 月至 2018 年 3 月进行的基于人群的前瞻性发病率研究，英国牛津郡的平均流域人口为 94 567 人。暴露时间、病前血管危险因素和职业。主要结果和措施按年龄、性别、诊断检查、病因和严重程度分层的中风、短暂性脑缺血发作 (TIA) 和其他主要血管事件（心肌梗塞、心源性猝死和外周血管事件）发生率的变化。结果 总共确定了 2429 例中风事件（平均年龄，73.6 [SD，14.4] 岁；51.3% 为女性）。从2002-2010年到2010-2018年，55岁以下参与者的卒中发病率显着增加（发病率比[IRR]，1.67；95% CI，1.31-2.14），但55岁或以上参与者的卒中发病率显着下降（IRR， 0.85；95% CI，0.78-0.92；P < .001 差异）。 55 岁以下人群的发病率显着增加，与性别、卒中严重程度、病理亚型和调查变化无关，TIA 中也出现这种情况（IRR，1.87；95% CI，1.36-2.57），但心肌梗死和其他主要血管事件（IRR，0.73；95% CI，0.58-0.93）。 尽管 55 岁以下的 TIA 和卒中与糖尿病（风险比 [RR]，3.47；95% CI，2.54-4.74）、高血压（RR，2.52；95% CI，2.04-3.12）、当前吸烟（ RR，2.38；95% CI，1.92-2.94）和肥胖（RR，1.36；95% CI，1.07-1.72），从 2002-2010 年到 2010-2018 年，在没有这些风险的个体中，发病率仍然显着增加因素。专业/管理职业增幅最大（IRR，2.52；95% CI，1.75-3.62），部分技能/非技能职业增幅最小（IRR，1.17；95% CI，0.79-1.74）。随着时间的推移，在没有已知血管危险因素的 55 岁以下人群中，TIA 和中风的比例显着增加（45 [30.4%] vs 115 [42.4%]；绝对差异，12.0%；95% CI，2.6-21.5），尤其是发生隐源性事件的患者（10 [18.5%] vs 63 [49.2%]；绝对差异，30.7%；95% CI，17.2-44.2；P < .001；异质性 P = .002）。结论和相关性 比较 2002 年至 2010 年与 2010 年至 2018 年居住在英国牛津郡的人们，55 岁以下人群的中风发病率显着增加，但 55 岁或以上人群的中风发病率有所下降。鉴于其他血管事件不存在这种差异，需要进一步研究来了解这种差异的原因。