Abstract Background and aims In high-income countries, stroke incidence in the 21st century has increased or stagnated among young and middle-aged individuals. Assessing trends in post-stroke outcomes is necessary to understand the impact of these changes in incidence. Methods Embase and Medline were searched from 1970 to 2024. We included studies that reported case-fatality, one- or five-year mortality, or stroke recurrence in patients aged ≤65 years at a minimum of two time points. Risk ratios (RR) were pooled using inverse-variance random-effects models. The annualized change in case-fatality was estimated using meta-regression. Results Twenty-two studies reported case-fatality in 28 populations (14 population-based, 14 hospital-based or administrative). The median (IQR) time between comparison points was 9 (7–13.25) years. Case-fatality decreased (RR=0.74, 95% CI: 0.68–0.81; I2=0.92), on average by 3.2% (1.4–5.0) per year. Results were consistent across age groups, sex, study methodology, and region. Trends were similar before and after 2000, with continued improvements after 2010. Among six studies reporting by subtype, trends were similar for ischaemic stroke (0.79, 0.75–0.83; 0.47) and intracerebral haemorrhage (0.77, 0.69–0.86; 0.93). Improvements were maintained at one year (5 studies; 0.68, 0.52–0.87; 0.70) and five years after stroke (4 studies; 0.65, 0.45–0.95; 0.77). In contrast, the risk of recurrent stroke was unchanged after 2000 (one-year cumulative risk after ischaemic stroke, 3 studies; 1.04, 0.78–1.39; 0.69). Conclusions Case-fatality and post-stroke survival have progressively improved since the 1970s in high-income countries among young and middle-aged individuals, but stroke recurrence rates may have stagnated in the past two decades. Conflict of interest Ahmad Nehme: funding by the Oxford University Clarendon Scholarship and the Fonds de Recherche du Québec. Linxin Li: funding by the NIHR Advanced Fellowship and the Oxford Brain Science Fellowship.
Nehme et al. (Fri,) studied this question.