Association of prediabetes with stroke in young metabolically healthy tobacco users: A population-based analysis

Diabetes and tobacco use are well-established risk factors for stroke. However, the intersection of prediabetes, tobacco use, and stroke among young individuals remains underexplored. This study aims to investigate the association between pre-diabetes and stroke risk in young tobacco users. Using the National Inpatient Sample (2019) and relevant ICD-10 codes, we identified young patients with tobacco use disorder and pre-diabetes. Regression analysis considered risk factors (gender, demographics, income, comorbidities) to assess stroke odds. Among 1,017,540 stroke hospitalizations, 1.9% were pre-diabetic. Pre-diabetics were often older (median age 36 vs. 31), male (59.4%), Black (33.8%), and Hispanic (12.2%), with higher rates of comorbidities, including drug abuse, alcohol abuse, COPD, and CKD (p < 0.001). They also exhibited higher rates of stroke events (1.9% vs. 0.5%, p < 0.001). Multivariable analysis after adjusting for confounders, young metabolically healthy smokers with pre-diabetes had a higher risk of stroke (aOR 3.31, 95% CI [1.67-6.55], p < 0.001). Prediabetes could potentially triple stroke risk in young tobacco smokers. Prospective research is warranted to explore the causal association between pre-diabetes and stroke in the setting of tobacco use.