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Twenty-Year Trends in Long-Term Mortality Risk in 17 149 Survivors of Ischemic Stroke Less Than 55 Years of Age

Background and Purpose— The purpose of the present study was to investigate the 4-year mortality risk among patients <55 years with a first ischemic stroke during 1987–2006. Methods— A total of 17 149 cases (37.4% women) aged 18 to 54 years who survived ≥28 days after a first ischemic stroke were identified in the Swedish Inpatient Register from 1987 to 2006. All patients were followed for 4 years or until death. The standardized mortality ratio was calculated by comparing the mortality rates with those of the general population of equivalent age, sex, and calendar year. Results— During the period, there were 1265 deaths. Long-term survival improved over time in both men and women. Among men, the mortality risk decreased by 32% (hazard ratio=0.68 [95% confidence interval, 0.56–0.82]) from the first 5-year period to the last 5-year period (1987–1991 versus 2002–2006), and among women, the mortality risk decreased by 45% (0.55 [0.41–0.75]). Despite an overall decrease in mortality, the standardized mortality ratios for the last 5-year period remained high: 5.88 (95% confidence interval, 5.10–6.71) for men and 5.91 (4.68–7.29) for women with an absolute excess risk of 1.60 and 0.97 per 100 person-years, respectively, with nearly half of all deaths related to cardiovascular disease. Conclusions— During the 20-year period, 4-year mortality decreased by one third but was still 6-fold higher than that of the general population in the most recent period, emphasizing the importance of secondary prevention in young persons who have had a stroke.