IMPORTANCE While stroke mortality rates have decreased substantially in the past 2 decades, this trend has been primarily limited to older adults. Increasing trends in stroke incidence and hospitalizations have been noted among younger adults, but there has been concern that this reflected improved diagnosis through an increased use of imaging rather than representing a real increase.OBJECTIVES To determine whether stroke hospitalization rates have continued to increase and to identify the prevalence of associated stroke risk factors among younger adults. DESIGN, SETTING, AND PARTICIPANTS Hospitalization data from the National Inpatient Sample from 1995 through 2012 were used to analyze acute stroke hospitalization rates among adults aged 18 to 64 years. Hospitalization data from 2003 to 2012 were used to identify the prevalence of associated risk factors for acute stroke. Acute stroke hospitalizations were identified by the principal International Classification of Diseases, Ninth Revision, Clinical Modification code and associated risk factors were identified by secondary International Classification of Diseases, Ninth Revision, Clinical Modification codes for each hospitalization. MAIN OUTCOMES AND MEASURES Trends in acute stroke hospitalization rates by stroke type, age, sex, and race/ethnicity, as well as the prevalence of associated risk factors by stroke type, age, and sex. RESULTS The 2003-2004 set included 362 339 hospitalizations and the 2011-2012 set included 421 815 hospitalizations.The major findings in this study are as follows: first, acute ischemic stroke hospitalization rates increased significantly for both men and women and for certain race/ethnic groups among younger adults aged 18 to 54 years; they have almost doubled for men aged 18 to 34 and 35 to 44 years since 1995-1996, with a 41.5% increase among men aged 35 to 44 years from 2003-2004 to 2011-2012. Second, the prevalence of stroke risk factors among those hospitalized for acute ischemic stroke continued to increase from 2003-2004 through 2011-2012 for both men and women aged 18 to 64 years (range of absolute increase: hypertension, 4%-11%; lipid disorders, 12%-21%; diabetes, 4%-7%; tobacco use, 5%-16%; and obesity, 4%-9%). Third, the prevalence of having 3 to 5 risk factors increased from 2003-2004 through 2011-2012 (men: from 9% to 16% at 18-34 years, 19% to 35% at 35-44 years, 24% to 44% at 45-54 years, and 26% to 46% at 55-64 years; women: 6% to 13% at 18-34 years, 15% to 32% at 35-44 years, 25% to 44% at 45-54 years, and 27% to 48% at 55-65 years; P for trend < .001). Finally, hospitalization rates for intracerebral hemorrhage and subarachnoid hemorrhage remained stable, with the exception of declines among men and non-Hispanic black patients aged 45 to 54 with subarachnoid hemorrhage (13.

Background: Heart failure (HF), a serious and costly condition, is increasingly prevalent. We estimated the US burden including emergency department (ED) visits, inpatient hospitalizations and associated costs, and mortality. Methods and Results: We analyzed 2006–2014 data from the Healthcare Cost and Utilization Project’s (HCUP) Nationwide ED Sample, the HCUP National (Nationwide) Inpatient Sample, and the National Vital Statistics System. ICD codes identified HF and comorbidities. Burden was estimated separately for ED visits, hospitalizations, and mortality. In addition, criteria were applied to identify total unique acute events. Rates of “primary HF” (primary diagnosis or underlying cause of death) and “comorbid HF” (comorbid diagnosis or contributing cause of death) were calculated, age-standardized to the 2010 US population. In 2014, there were an estimated 1,068,412 ED visits, 978,135 hospitalizations, and 83,705 deaths with primary HF. There were 4,071,546 ED visits, 3,370,856 hospitalizations, and 230,963 deaths with comorbid HF. Between 2006–2014, the total unique acute event rate for primary HF declined from 536 to 449 per 100,000 [Relative percent change (RPC) of −16%, p for trend <0.001], but increased for comorbid HF from 1,467 to1,689 per 100,000 (RPC 15%, p for trend<0.001). HF-related mortality decreased significantly from 2006–2009 but did not change meaningfully after 2009. For hospitalizations with primary HF, the estimated mean cost was $11,552 in 2014, totaling an estimated $11 billion. Conclusions: Given substantial healthcare and mortality burden of HF, rising healthcare costs, and the aging US population, continued improvements in HF prevention, management, and surveillance are important.

Increases in the prevalence of ischemic stroke hospitalizations and coexisting traditional stroke risk factors and health risk behaviors were identified among acute ischemic stroke hospitalizations in young adults. Our results from national surveillance data accentuate the need for public health initiatives to reduce risk factors for stroke among adolescents and young adults.