---
title: "Young-onset stroke in the UAE: risk factors, subtypes, and outcomes from a single-centre study"
id: "plos-one-19-young-onset-stroke-in-the-uae-a-single-centre-retrospective-analysis-of-risk"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-19-young-onset-stroke-in-the-uae-a-single-centre-retrospective-analysis-of-risk"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355300"
published_at: "2026-08-06T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Young-onset stroke in the UAE: risk factors, subtypes, and outcomes from a single-centre study
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-19-young-onset-stroke-in-the-uae-a-single-centre-retrospective-analysis-of-risk
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355300)
- **Published At:** 2026-08-06T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This retrospective single-centre study reviewed 419 patients younger than 50 years admitted with stroke to Al Qassimi Hospital, Sharjah, UAE, between 2016 and 2022. - The population was predominantly male (78.28%) and largely from **South Asia** (63.96%) and the MENA region (19.33%). - Stroke subtype distribution: **ischemic stroke** 50.12%, intracerebral hemorrhage 27.21%, and non-traumatic subarachnoid hemorrhage 22.67%. - The most common comorbidities were **hypertension** (45.45%) and **diabetes mellitus** (24.42%); hyperlipidaemia, coronary artery disease, and atrial fibrillation were also recorded. - Reperfusion interventions were infrequent: intravenous thrombolysis in 9.41% and mechanical thrombectomy in 0.24% of patients. - Overall mortality was 12.68%; coronary artery disease showed a significant association with death (p < 0.001). - South Asian ethnicity was associated with higher likelihood of large-artery atherosclerosis (OR 2.19; 95% CI 1.11–4.30; p = 0.02). - Data were extracted via ICD-10 case identification followed by manual chart review; stroke aetiology was taken from treating neurologists’ final diagnoses and no de novo TOAST adjudication was performed. - The authors highlight a high burden of modifiable cardiovascular risk factors among young stroke patients in the UAE and call for targeted preventive strategies and region-specific research.
## Clinical Analysis & Structured Key Points
Young-onset stroke in the UAE: A single-centre retrospective analysis of risk factors and outcomes | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Reader Comments Figures Figures Abstract Background Young-onset stroke represents a growing public health concern, yet data from the United Arab Emirates (UAE) remain limited. This study aimed to examine the risk factors and clinical outcomes associated with young-onset stroke in the UAE. Methods A retrospective chart review was conducted on 419 patients aged below 50 years who were admitted at Al Qassimi Hospital, Sharjah, UAE, with a diagnosis of stroke between 2016 and 2022. Data on demographics, comorbidities, stroke subtype, management, and outcomes were collected and analyzed using Python-based statistical libraries. Results The study population comprised predominantly of male individuals (78.28%), with most patients originating from South Asia (63.96%) and the Middle East and North Africa region (19.33%). Ischemic stroke was the most common subtype (50.12%), followed by intracerebral hemorrhage (27.21%) and non-traumatic subarachnoid hemorrhage (22.67%). Hypertension (45.45%) and diabetes mellitus (24.42%) were the most prevalent comorbidities. Only 0.24% of patients underwent mechanical thrombectomy, and 9.41% received intravenous thrombolysis. The overall mortality rate was 12.68%, with coronary artery disease significantly associated with death (p 24 hours), are performed at the discretion of the treating physician based on individual risk factors. Implantable loop recorders are not utilized at the centre. Data collection A comprehensive literature review was conducted to identify gaps in the existing knowledge regarding stroke epidemiology, management, and outcomes. Based on this review, a structured data collection spreadsheet was developed to facilitate consistent and thorough manual data entry. The data collected encompassed a wide range of variables, including demographic information (age, sex, and region of origin), comorbid health conditions (hypertension, diabetes mellitus, hyperlipidaemia, coronary artery disease and atrial fibrillation), past medical history, and family history of stroke or cardiovascular diseases. Details of clinical assessment including vital signs (blood pressure, heart rate), BMI, and glucose levels on admission were also noted. Furthermore, details of imaging results, type of stroke (ischemic or hemorrhagic), hemorrhagic transformation within 24 hours, ECG changes, basic blood workup, treatment interventions (thrombolytic therapy, anticoagulation, or mechanical thrombectomy), and outcomes (including survival) were also documented. Stroke subtype (ischemic stroke, non-traumatic intracerebral hemorrhage and non-traumatic subarachnoid hemorrhage [SAH, to refer to non-traumatic SAH from hereon]) and aetiology were extracted from electronic medical records based on the final diagnosis documented by the treating neurologist and the corresponding ICD-10 code. A de novo adjudication using strict TOAST criteria was not performed during this retrospective study. Inclusion and exclusion criteria Patients under the age of 50 years who presented with clinical signs consistent with stroke (e.g., acute onset of focal weakness, speech disturbance, paraesthesia, ataxic gait, visual field defects, etc), confirmed via neuroimaging (non-contrast CT scan of the head), after reasonable exclusion of common stroke mimics (e.g., hypoglycaemia, seizure, etc) were included in the study. Exclusion criteria included traumatic intracranial bleeding, intracranial masses presenting with stroke-like symptoms and those diagnosed with transient ischemic attack. No patients during the study period were excluded based on region of origin, sex or other demographic variables. Sample size A total of 419 patients met the inclusion criteria and were included in the analysis. While no formal minimum sample size calculation was performed due to the retrospective nature of the study, existing literature suggests that sample sizes of 100 patients or more are generally sufficient for summarizing categorical and continuous variables in observational studies. Furthermore, samples in the range of 200–400 charts have been shown to provide reasonably precise estimates, with 95% confidence intervals typically within 5–15% of the mean [ 11 ]. Statistical analysis Data was imported into python 3 and analyzed using the Matplotlib v3.3.4, pandas v1.2.4, statsmodels v0.12.2, and scipy-v1.10.0, packages. For each variable, appropriate groupings were defined and used based on similarity or previous literature. Missingness was dealt with on a case-by-case basis, and during bivariate analysis, through pairwise deletion. Patient regions of origin were aggregated to the 21 regions as defined by the 2023 Global Burden of Disease framework [ 12 ]. For analysis purposes, the regions were further aggregated into four primary categories: MENA, South Asia, Sub-Saharan Africa, and Others. This aggregation aligns with broader regional taxonomies used in multiregional cohorts [ 13 ]. Chi-squared tests were used for bivariate analyses given the categorical nature of the variables. P values less than 0.05 were taken to be significant. Results A total of 537 cases were initially extracted from the electronic medical records. Duplicate entries (strictly defined as redundant records sharing the same Encounter ID and admission date) and cases with more than 50% missing data were dropped during data cleaning ( Fig 1 ). Download: PNG larger image TIFF original image Fig 1. Patient selection flowchart. https://doi.org/10.1371/journal.pone.0355300.g001 As such, 419 patients were included in the study. The majority of patients were of South Asian origin (63.96%, n = 268), followed by patients from the MENA region (19.33%, n = 81), and a smaller proportion from other regions (11.22%, n = 47) and Sub-Saharan Africa (5.49%, n = 23). Most patients were male (78.28%, n = 328), and mean age was 39.99 ± 7.24. Further demographic details are displayed in Table 1 . Download: PNG larger image TIFF original image Table 1. Demographic Characteristics of Study Participants. https://doi.org/10.1371/journal.pone.0355300.t001 Regarding stroke type, ischemic stroke was the most prevalent, accounting for 50.12% (n = 210) of cases, followed by intracerebral hemorrhage (27.21%, n = 114) and SAH (22.67%, n = 95). On admission, ECG findings showed that 56.63% (n = 141/249) of patients had a normal sinus rhythm, 18.07% (n = 45/249) had left ventricular hypertrophy, and 25.30% (n = 63/249) presented with other abnormalities. Only a small proportion of patients had a family history of stroke (2.44%, n = 3/123), and 4.67% (n = 17/364) had a previous personal history of stroke. Atrial fibrillation was observed in only 1.05% (n = 4/380) of patients. Hypertension was present in 45.45% (n = 175/385) of patients, while 24.42% (n = 94/385) had diabetes mellitus, and 7.14% (n = 27/378) had history of coronary heart disease. Among female patients, 1.10% (n = 1/91) reported using oral contraceptives. Most patients (98.71%, n = 384/389) were not on warfarin or heparin prior to admission. Significant differences in the distribution of the type of stroke were observed based on region of origin (p < 0.001), sex (p < 0.001) and diabetes mellitus status (p = 0.007). Females were 2.23 times more likely to have a hemorrhagic stroke than males (95% CI: 1.37–3.65, p = 0.001). Conversely, patients with ischemic strokes were 2.13 times more likely to have diabetes mellitus as a comorbidity than those with hemorrhagic stroke (95% CI: 1.17–3.88, p = 0.014). Interestingly, hypertension was not significantly associated with hemorrhagic transformation within 24 hours (p = 0.38). Further clinical characteristics are displayed in Table 2 . Download: PNG larger image TIFF original image Table 2. Clinical Characteristics of Study Participants. https://doi.org/10.1371/journal.pone.0355300.t002 Cardioembolic stroke was identified in 2.82% (n = 8/284) of cases, and thrombophilia was present in 1.90% (n = 3/158) of patients. Large-artery atherosclerosis was observed in 22.47% (n = 60/267) of cases, and small-vessel disease was identified in 13.99% (n = 48/343). The cause of stroke remained undetermined in 46.78% (n = 196/419) of patients. Regarding prognosis, patients with hemorrhagic strokes were 3.41 times more likely to have in-hospital mortality compared to those with ischemic strokes (95% CI: 1.73–6.69, p < 0.001). In terms of treatment, intravenous thrombolytic therapy was administered to 9.41% (n = 37/393) of patients, with abciximab being administered with IV tPA in only 0.60% (n = 1/166) of cases. Aspirin was given to 42.24% (n = 177/419) of patients, while mechanical thrombectomy was performed in 0.24% (n = 1/409) of cases. Hemorrhagic transformation occurred in 6.19% (n = 21/339) of patients. The overall mortality rate was 12.68% (n = 53/418). Importantly, those with a history of coronary artery disease had 4.65 times higher mortality rates (p < 0.001).A subgroup univariate analysis comparing South Asian and non-South Asian patients was conducted. Compared to the non-South Asian group, South Asian patients were 4.82 times more likely to receive intravenous thrombolytic therapy (95% CI: 4.22–5.51, p < 0.001) and 2.19 times more likely to present with large-artery atherosclerosis (95% CI: 1.11–4.30, p = 0.02). Interestingly, the overall mortality was comparable between the groups (12.36% in South Asians vs. 13.25% in non-South Asians, p = 0.10). Detailed overview of the comparative outcomes between the two groups is highlighted in Table 3 . Download: PNG larger image TIFF original image Table 3. Comparison of baseline characteristics, management, and outcomes of ischemic stroke in South Asian vs non-South Asian patients. https://doi.org/10.1371/journal.pone.0355300.t003 Discussion This study offers significant insights into the demographic and clinical characteristics of young-onset stroke patients in the UAE, with a particular focus on risk factors, outcomes, and the unique demographic composition of those patients. In this study the majority of patients with young-onset stroke were from South Asia, followed by the MENA region; this reflects the UAE's racial/ethnic composition, with South Asian people contributing to 59.4% of the population [ 14 ]. In contrast, studies conducted in other MENA countries, such as Saudi Arabia and Kuwait, typically involve a larger proportion of native populations. In one particular Saudi study, most of the stroke patients were native Saudis [ 15 ]. Similar to our findings, males made up the majority of the stroke cohort in the MENA region, reflecting a higher stroke incidence among males, which has also been documented globally [ 16 ]. Data on the unique characteristics of young-onset stroke patients is limited. In our cohort, ischemic stroke was the most common type, accounting for about half of the cases, while intracerebral hemorrhage and SAH each comprised approximately a quarter. These findings contrast with a large-scale study conducted in the MENA region, which reported 13.9% of stroke cases as hemorrhagic and only 1.0% as SAH [ 16 ]. The higher prevalence of SAH in our cohort reflects reported epidemiological differences of young-onset stroke; hemorrhagic stroke frequently comprise a larger proportion in young individuals when compared to older individuals [ 17 ]. Furthermore, while our centre serves as the primary stroke referral facility for the Emirate of Sharjah, it is not a specialized neurosurgical hub for complex aneurysm interventions; thus, this distribution suggests a genuine demographic trend rather than a surgical selection bias. Given that hypertension is a dominant risk factor for hemorrhagic strokes, and intracerebral hemorrhage being strongly associated with diabetes mellitus, these results highlight the need for more aggressive prevention and management strategies targeting modifiable risk factors in the UAE. When compared to data from Western nations, like the United States (US) and European nations, some key differences emerge. In our study, the prevalence of hypertension (45%) and diabetes mellitus (24%) was notably higher than that observed in stroke cohorts in Western nations. For example, studies from the US report hypertension in about 35% of stroke patients, with diabetes mellitus affecting approximately 20% of cases [ 18 ]. This suggests that stroke patients in the UAE may have a heavier burden of these comorbidities. Additionally, the male predominance (78%) in our study is more pronounced than in studies from the West, where sex disparities are less stark, potentially reflecting regional lifestyle and occupational differences [ 1 , 19 ]. It is important to interpret the observed associations between region of origin and stroke subtype within the socioeconomic context of the UAE. For instance, region of origin frequently correlates with occupational status and insurance tiers. In our study, South Asian patients were disproportionately affected by young-onset stroke and had a significantly higher prevalence of large-artery atherosclerosis. While t
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