Department of Neurology (M.H.L., S.N.P.), University of Colorado School of Medicine, Aurora.
Adult and Child Consortium for Health Outcomes Research and Delivery Science (M.H.L., S.S.), University of Colorado School of Medicine, Aurora.
Circ Cardiovasc Qual Outcomes. 2024 Apr;17(4):e010307. doi: 10.1161/CIRCOUTCOMES.123.010307. Epub 2024 Mar 26.
Despite women having fewer traditional risk factors (eg, hypertension, diabetes), strokes are more common in women than men aged ≤45 years. This study examined the contributions of traditional and nontraditional risk factors (eg, migraine, thrombophilia) in the development of strokes among young adults.
This retrospective case-control study used Colorado's All Payer Claims Database (2012-2019). We identified index stroke events in young adults (aged 18-55 years), matched 1:3 to stroke-free controls, by (1) sex, (2) age±2 years, (3) insurance type, and (4) prestroke period. All traditional and nontraditional risk factors were identified from enrollment until a stroke or proxy-stroke date (defined as the prestroke period). Conditional logistic regression models stratified by sex and age group first assessed the association of stroke with counts of risk factors by type and then computed their individual and aggregated population attributable risks.
We included 2618 cases (52% women; 73.3% ischemic strokes) and 7827 controls. Each additional traditional and nontraditional risk factors were associated with an increased risk of stroke in all sex and age groups. In adults aged 18 to 34 years, more strokes were associated with nontraditional (population attributable risk: 31.4% men and 42.7% women) than traditional risk factors (25.3% men and 33.3% women). The contribution of nontraditional risk factors declined with age (19.4% men and 27.9% women aged 45-55 years). The contribution of traditional risk factors peaked among patients aged 35 to 44 years (32.8% men and 39.7% women). Hypertension was the most important traditional risk factor and increased in contribution with age (population attributable risk: 27.8% men and 26.7% women aged 45 to 55 years). Migraine was the most important nontraditional risk factor and decreased in contribution with age (population attributable risk: 20.1% men and 34.5% women aged 18-35 years).
Nontraditional risk factors were as important as traditional risk factors in the development of strokes for both young men and women and have a stronger association with the development of strokes in adults younger than 35 years of age.
尽管女性的传统风险因素（如高血压、糖尿病）较少，但≤45 岁的女性中风发病率高于男性。本研究旨在探讨传统和非传统风险因素（如偏头痛、血栓形成倾向）在年轻成年人中风发病中的作用。
这是一项回顾性病例对照研究，使用了科罗拉多州的所有支付者索赔数据库（2012-2019 年）。我们通过（1）性别，（2）年龄±2 岁，（3）保险类型和（4）发病前阶段，在年轻成年人（18-55 岁）中确定了中风事件作为索引。将符合条件的患者与无中风对照者以 1:3 的比例进行匹配，匹配因素为（1）性别，（2）年龄±2 岁，（3）保险类型，（4）发病前阶段。所有传统和非传统风险因素均从入组到中风或代理中风日期（定义为发病前阶段）确定。分层性别和年龄组的条件逻辑回归模型首先评估了风险因素数量与中风的关联，然后计算了它们的个体和总体人群归因风险。
我们纳入了 2618 例病例（52%为女性；73.3%为缺血性中风）和 7827 例对照。在所有性别和年龄组中，每增加一个传统和非传统风险因素，中风的风险就会增加。在 18 至 34 岁的成年人中，与非传统风险因素（人群归因风险：31.4%的男性和 42.7%的女性）相比，更多的中风与传统风险因素（25.3%的男性和 33.3%的女性）有关。非传统风险因素的贡献随着年龄的增长而下降（45-55 岁的男性和女性为 19.4%和 27.9%）。传统风险因素的贡献在 35-44 岁的患者中达到峰值（32.8%的男性和 39.7%的女性）。高血压是最重要的传统风险因素，且其贡献随年龄的增长而增加（45-55 岁的男性和女性的人群归因风险分别为 27.8%和 26.7%）。偏头痛是非传统风险因素中最重要的因素，且其贡献随年龄的增长而下降（18-35 岁的男性和女性人群归因风险分别为 20.1%和 34.5%）。
非传统风险因素与传统风险因素在年轻男性和女性中风的发生中同样重要，且与 35 岁以下成年人中风的发生关系更为密切。
