---
title: "Trends in stroke incidence and modifiable risk factors in England (2018–2024): age-specific change"
id: "plos-medicine-0-time-trends-in-stroke-incidence-and-modifiable-risk-factor-prevalence-in"
canonical_url: "https://medichelpline.com/clinical-feed/plos-medicine-0-time-trends-in-stroke-incidence-and-modifiable-risk-factor-prevalence-in"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "PLOS Medicine"
source_url: "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999"
published_at: "2026-08-07T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Trends in stroke incidence and modifiable risk factors in England (2018–2024): age-specific change
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-medicine-0-time-trends-in-stroke-incidence-and-modifiable-risk-factor-prevalence-in
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** PLOS Medicine
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999)
- **Published At:** 2026-08-07T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- The study used nation-wide record linkage in England to identify first-ever **stroke** events between 1 April 2018 and 31 March 2024 from overlapping data sources (primary care, hospital admissions, death certification, and a stroke audit). - A total of 643,885 incident strokes were included (2018–2020: 206,290; 2020–2022: 211,420; 2022–2024: 226,175). - Age-specific analyses compared adults <55 years versus ≥55 years across three periods: pre-pandemic (2018–2020), pandemic (2020–2022), and post-pandemic (2022–2024). - During the pandemic, stroke incidence increased at **younger ages** (<55 years) compared with pre-pandemic (IRR = 1.07, 95% CI 1.05–1.09), and the increase continued post-pandemic (2022–2024 vs 2020–2022: IRR = 1.04, 95% CI 1.02–1.06). - Stroke incidence at age ≥55 years remained stable during the pandemic (IRR = 0.99, 95% CI 0.99–1.00) and rose post-pandemic (IRR = 1.04, 95% CI 1.03–1.04). - The age divergence (worse trend at younger ages) widened significantly during the pandemic (RTTR = 1.07, 95% CI 1.05–1.08) and did not reverse subsequently (RTTR change post-pandemic non-significant). - The increase at younger ages was consistent across sex, deprivation, region, and stroke subtypes, and was most pronounced in **ethnic minority** groups (Black: IRR 1.13; Asian: IRR 1.26 during pandemic vs pre-pandemic). - Overall prevalence of recorded modifiable risk factors (hypertension, diabetes, atrial fibrillation, hyperlipidaemia) remained largely unchanged across periods for both age groups. - However, there was an increase in the frequency of previously **undiagnosed premorbid hypertension and diabetes** among adults <55 years during the pandemic (hypertension RR = 1.07; diabetes RR = 1.22), particularly in ethnic minority groups, and this did not improve after the pandemic. - The study notes the limitation of routinely collected data lacking granularity to determine mechanistic drivers and acknowledges potential biases despite using multiple linked sources to reduce ascertainment issues. - Authors conclude urgent attention is needed to address missed opportunities in primary care screening and diagnosis to mitigate rising stroke incidence at younger ages.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosmedicine%2Farticle%3Fid%3D10.1371%2Fjournal.pmed.1004999) * * About * Browse * Publish * [](https://journals.plos.org/plosmedicine/ "PLOS Medicine") * Search [advanced search](https://journals.plos.org/plosmedicine/search) * 0 [Save](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1004999#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1004999#savedHeader) * 0 [Citation](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1004999#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1004999#citedHeader) * 27 [View](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1004999#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1004999#viewedHeader) * 0 [Share](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1004999#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1004999#discussedHeader) Open Access Peer-reviewed Research Article # Time trends in stroke incidence and modifiable risk factor prevalence in England (2018–2024): A record linkage population-based study * Joseph Kamtchum-Tatuene, Roles Data curation, Formal analysis, Funding acquisition, Methodology, Writing – original draft, Writing – review & editing Affiliation Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-1041-4202 ](https://orcid.org/0000-0002-1041-4202 "ORCID Registry") ⨯ * James Farrell, Roles Data curation, Methodology, Writing – original draft, Writing – review & editing Affiliation British Heart Foundation Data Science Centre, Health Data Research UK, London, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-5665-4519 ](https://orcid.org/0000-0002-5665-4519 "ORCID Registry") ⨯ * John Nolan, Roles Data curation, Methodology, Writing – original draft, Writing – review & editing Affiliation British Heart Foundation Data Science Centre, Health Data Research UK, London, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-5342-0514 ](https://orcid.org/0000-0002-5342-0514 "ORCID Registry") ⨯ * Sarah Lessels, Roles Project administration, Writing – original draft, Writing – review & editing Affiliation British Heart Foundation Data Science Centre, Health Data Research UK, London, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-7373-3067 ](https://orcid.org/0000-0002-7373-3067 "ORCID Registry") ⨯ * William N. Whiteley, Roles Methodology, Project administration, Resources, Writing – original draft, Writing – review & editing Affiliations British Heart Foundation Data Science Centre, Health Data Research UK, London, United Kingdom, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-4816-8991 ](https://orcid.org/0000-0002-4816-8991 "ORCID Registry") ⨯ * Linxin Li , Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Methodology, Project administration, Resources, Supervision, Visualization, Writing – original draft, Writing – review & editing * E-mail: linxin.li@ndcn.ox.ac.uk Affiliation Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-3636-8355 ](https://orcid.org/0000-0002-3636-8355 "ORCID Registry") ⨯ * on behalf of the CVD-COVID-UK/COVID-IMPACT Consortium # Time trends in stroke incidence and modifiable risk factor prevalence in England (2018–2024): A record linkage population-based study * Joseph Kamtchum-Tatuene, * James Farrell, * John Nolan, * Sarah Lessels, * William N. Whiteley, * Linxin Li, … * on behalf of the CVD-COVID-UK/COVID-IMPACT Consortium ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: August 7, 2026 * * [Article](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999) * [Authors](https://journals.plos.org/plosmedicine/article/authors?id=10.1371/journal.pmed.1004999) * [Metrics](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1004999) * [Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1004999) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pmed.1004999) * [Peer Review](https://journals.plos.org/plosmedicine/article/peerReview?id=10.1371/journal.pmed.1004999) * [Abstract](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#abstract0) * [Author summary](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#abstract1) * [Introduction](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#sec007) * [Methods](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#sec008) * [Results](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#sec014) * [Discussion](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#sec016) * [Supporting information](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#sec017) * [Acknowledgments](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#ack) * [References](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#references) * [Reader Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1004999) * [Figures](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999) [?](https://journals.plos.org/plosmedicine/s/accepted-manuscripts#loc-early-version) ## This is an uncorrected proof. ## Abstract ### Background The incidence of stroke at younger ages appears to be increasing, whilst it is falling at older ages. We aimed to determine the current trend and how it might have changed during and after the COVID-19 pandemic. ### Methods and findings We identified first-ever stroke events in adults in England between 1st April 2018 and 31st March 2024 through record-linkage with multiple overlapping sources including primary care, hospital admission, death certificate, and records from a stroke specific national audit. Standardised age-specific (age ). The CVD-COVID-UK/COVID-IMPACT research programme, led by the BHF Data Science Centre ( ), received approval to access data in NHS England’s SDE service for England from the Advisory Group for Data (AGD) ( ) – formerly the Independent Group Advising on the Release of Data (IGARD) – via an application made in the Data Access Request Service (DARS) Online system (ref. DARS-NIC-381078-Y9C5K) ( ). The CVD-COVID-UK/COVID-IMPACT Approvals & Oversight Board ( ) subsequently granted approval to this project (CCU084) to access the data within NHS England’s SDE service for England. The anonymised data used in this study were made available to accredited researchers only. Those wishing to gain access to the data should contact bhfdsc@hdruk.ac.uk in the first instance and follow the application process of the relevant national data custodian ( ). A pre-specified analysis plan is published on GitHub, along with the phenotyping and analysis code ( ) (DOI: ). **Funding:** This work was carried out with the support of the BHF Data Science Centre led by HDR UK (BHF Grant no. SP/19/3/34678, awarded to Health Data Research (HDR) UK). The British Heart Foundation Data Science Centre ( ) funded co-development (with NHS England) of the Secure Data Environment service for England, provision of linked datasets, data access, user software licences, computational usage, and data management and wrangling support, to coordinate national COVID-19 priority research. Consortium partner organisations funded the time of contributing data analysts, biostatisticians, epidemiologists, and clinicians. The National Stroke Audit SSNAP is funded by the Healthcare Quality Information Partnership (HQIP) on behalf of NHS England. For this particular project, we were directly funded by the Stroke Catalyst ( ) and the UK Stroke Association ( ) (HDRUK2024.0093 to JKT and LL). Other author-specific funding source for salary support includes Wellcome Trust Early Career Award ( ; 304532/Z/23/Z to JKT) and NIHR Advanced Fellowship ( ; NIHR303662 to LL). JF, JN, SL, and WNW are part of the BHF Data Science Centre’s Health Data Team, who provided data curation resources and support. **Competing interests:** The authors have declared that no competing interests exist. **Abbreviations:** BHF, British Heart Foundation; GDPPR, GP Extraction Service Data for Pandemic Planning and Research dataset; HES, Hospital Episodes Statistics; ICD 10, International Classification of Diseases 10th revision; IRR, incidence rate ratio; IRRs, incidence rate ratios; NHS, National Health Service; NIHSS, National Institutes of Health Stroke Scale; RR, risk ratio; RTTR, relative temporal trend ratio; SSNAP, Sentinel Stroke National Audit Programme. ## Introduction Although stroke incidence has decreased by about 42% in high-income countries over the last four decades, this is predominantly driven by a decline at older ages [[1](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#pmed.1004999.ref001)–[3](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#pmed.1004999.ref003)]. In younger people (under 55 years), there has been a doubling in stroke incidence over the last 10 years in the UK, and a consistent age-specific divergence in all other high-income countries, with a less favourable trend at younger ages [[2](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#pmed.1004999.ref002),[4](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#pmed.1004999.ref004)]. However, available data only looked time trends until 2018 and little is known about the ongoing trend, especially in more recent periods, during and after the COVID-19 pandemic. There are several potential causes of different stroke incidence trends in younger and older people. First, SARS-CoV-2 infection is associated with short-term risk of stroke with some evidence of a stronger effect at younger ages [[5](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#pmed.1004999.ref005)]. Second, the adenovirus-based COVID-19 vaccines were associated with intracranial venous thrombosis at age < 70 years, an otherwise rare cause of stroke [[6](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#pmed.1004999.ref006),[7](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004999#pmed.1004999.ref007)]. Third, particularly during the pandemic, the control of vascular risk has declined, with fewer face-to-ace primary care appointment and prescription of antihypertensive, lipid lowering drugs and anticoagulation for atrial fibrillation [[8](https://journals.plos.org/plosmedicine/articl
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