Compare stroke risk factors, post-stroke complications, and mortality between young (<50 years) and older (>50 years) adults with stroke in Zambia.

Stroke epidemiology among young adults remains under-studied in sub-Saharan African countries, including Zambia.

We conducted a retrospective cohort study of consecutive adults admitted with stroke to the neurology inpatient service at University Teaching Hospital in Lusaka, Zambia between October 2018 – April 2019. We collected demographics, risk factors, in-hospital complications and hospital outcomes. Post-discharge outcomes were ascertained by telephone. Variables were compared between participants <50 years (younger adults) and participants >50 years (older adults) in the overall cohort and among those with ischemic and hemorrhagic stroke.

In the overall cohort (n=323), younger adults (n=106, 33%) had higher rate of HIV (39% vs. 12%, p<0.001) while older adults (n=217) had higher rates of hypertension (88% vs 63%, p<0.001), diabetes (21% vs. 5%, p<0.001), and atrial fibrillation (12% vs 3%, p=0.004). Among participants with ischemic stroke (n=188), older adults constituted the majority (n=141, 75%) and had higher rates of hypertension (87% vs. 40%, p<0.001) and heart disease (46% vs. 26%, p=0.01) while younger adults had higher rates of HIV (52% vs. 12%, p<0.001). Among individuals with hemorrhagic stroke, younger participants were majority (n=48, 53%).  Older adults with ischemic stroke had higher 3-month post-discharge mortality (43% vs. 17%, p=0.001).

Young adults constituted one-third of this stroke cohort and majority of participants with hemorrhagic stroke. Young adults with ischemic stroke were less likely to have traditional stroke risk factors like hypertension, but more than half had HIV infection. Older adults with ischemic stroke died at significantly higher rates in the first 90-days after discharge.  These data demonstrate necessity for targeted primary prevention strategies especially among people with HIV, and directed interventions to improve post-discharge mortality amongst older adults with ischemic stroke.