Age-related differences under the influence of risk factors for ischemic stroke mortality
1
The First Affiliated Hospital of China Medical University, Liaoning Province, China
Popul. Med. 2026;8(Supplement Supplement 1):A84
ABSTRACT
BACKGROUND:
Stroke remains a leading cause of mortality and long-term disability worldwide, particularly in aging populations. Most epidemiological studies implicitly assume that the associations between traditional vascular risk factors and post-stroke mortality are uniform across age groups. This assumption may obscure important age-related heterogeneity that is critical for adult and older population health planning.
METHODS:
We analyzed a longitudinal cohort of patients with first-ever ischemic stroke between 2003 and 2024. Mortality risk was assessed using two complementary approaches: Cox proportional hazards models stratified by baseline age (≤63, 64–73, ≥74 years) and Poisson regression models stratified by attained age during follow-up (≤73, 74–82, ≥83 years). Age strata were defined to ensure comparable numbers of outcome events across groups.
RESULTS:
Traditional vascular risk factors such as hypertension, hyperlipidemia, and coronary heart disease showed broadly consistent associations with mortality across age groups. In contrast, pronounced age-dependent heterogeneity was observed for metabolic, hematological, and behavioral factors. Diabetes was strongly associated with increased mortality in younger and middle-aged patients (HR = 2.01 and 2.09, respectively), but not among the oldest group (HR = 1.13). Hematological abnormalities, including high platelet count, low hematocrit, and low red blood cell count, exhibited markedly stronger associations with mortality at younger attained ages. Elevated white blood cell count and smoking were associated with excess mortality primarily in younger and middle-aged patients, while alcohol cessation was paradoxically associated with increased risk in younger patients.
CONCLUSIONS:
Mortality risk following ischemic stroke is strongly age-dependent, with metabolic, inflammatory, hematological, and behavioral factors exerting disproportionate effects in younger and middle-aged adults compared with older patients. These findings highlight the importance of adopting age-specific secondary prevention strategies and life-course–informed management approaches in stroke care, with implications for adult and aging population health, non-communicable disease control, and health system resource allocation.
Stroke remains a leading cause of mortality and long-term disability worldwide, particularly in aging populations. Most epidemiological studies implicitly assume that the associations between traditional vascular risk factors and post-stroke mortality are uniform across age groups. This assumption may obscure important age-related heterogeneity that is critical for adult and older population health planning.
METHODS:
We analyzed a longitudinal cohort of patients with first-ever ischemic stroke between 2003 and 2024. Mortality risk was assessed using two complementary approaches: Cox proportional hazards models stratified by baseline age (≤63, 64–73, ≥74 years) and Poisson regression models stratified by attained age during follow-up (≤73, 74–82, ≥83 years). Age strata were defined to ensure comparable numbers of outcome events across groups.
RESULTS:
Traditional vascular risk factors such as hypertension, hyperlipidemia, and coronary heart disease showed broadly consistent associations with mortality across age groups. In contrast, pronounced age-dependent heterogeneity was observed for metabolic, hematological, and behavioral factors. Diabetes was strongly associated with increased mortality in younger and middle-aged patients (HR = 2.01 and 2.09, respectively), but not among the oldest group (HR = 1.13). Hematological abnormalities, including high platelet count, low hematocrit, and low red blood cell count, exhibited markedly stronger associations with mortality at younger attained ages. Elevated white blood cell count and smoking were associated with excess mortality primarily in younger and middle-aged patients, while alcohol cessation was paradoxically associated with increased risk in younger patients.
CONCLUSIONS:
Mortality risk following ischemic stroke is strongly age-dependent, with metabolic, inflammatory, hematological, and behavioral factors exerting disproportionate effects in younger and middle-aged adults compared with older patients. These findings highlight the importance of adopting age-specific secondary prevention strategies and life-course–informed management approaches in stroke care, with implications for adult and aging population health, non-communicable disease control, and health system resource allocation.
| eISSN: | 2654-1459 |
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