New Delhi: One in seven stroke patients in India is younger than 45 years. Nearly two in five reach hospital more than 24 hours after the onset of symptoms. Three months later, more than half either die or suffer significant disability.
These findings come from India’s largest hospital-based stroke registry analysis, published in ‘International Journal of Stroke’. The study was led by Prashant Mathur of ICMR–National Centre for Disease Informatics and Research (ICMR-NCDIR), Bengaluru, along with investigators of the National Stroke Registry Programme.
The analysis reviewed 34,792 stroke cases recorded across 30 hospitals between 2020 and 2022, providing one of the most detailed national snapshots of stroke patterns, treatment gaps and outcomes.
The mean age of patients was 59.4 years, but 13.8% were under 45, underlining the growing burden of stroke among younger Indians. Nearly 63.4% were men and 72.1% came from rural areas, reflecting disparities in awareness, prevention and access to timely care.
Hypertension was present in 74.5% of patients, making it the dominant risk factor. Diabetes affected 27.3%, smokeless tobacco use 28.5%, tobacco smoking 22.6% and alcohol use 20.2%.
The study also noted gender differences — women had higher rates of hypertension and diabetes, while men reported greater tobacco and alcohol use.
The time taken to get treatment remained the biggest hurdle, according to the analysis. Only 20% reached hospital within the crucial 4.5-hour window for emergency stroke treatment. In contrast, 37.8% reached hospital after 24 hours. As a result, just 4.6% of ischemic stroke patients received intravenous thrombolysis and 0.7% underwent mechanical thrombectomy, it said. Delayed arrival, imaging delays and non-availability of medicines were key reasons for missing treatment.
Ischemic strokes accounted for 60% of cases, while intracerebral haemorrhage made up 34.2%.
Dr Manjari Tripathi, head of neurology at AIIMS Delhi, said the numbers reinforced a basic message. “Patients must reach the hospital within three hours. Immediate brain imaging is essential, and, if eligible, thrombolysis should be given without delay. Time is brain — every minute lost means neurons lost, leading to disability and long-term dependence. It is vital that people recognise stroke symptoms and seek emergency care early,” she said.
Outcomes remain stark as in-hospital mortality was 13.9%, but by three months, nearly 28% had died, indicating that many patients passed away after discharge. In total, more than half had a poor outcome, defined as death or significant disability. Women were more likely than men to have a disability at follow-up, suggesting possible gaps in rehabilitation and post-discharge care. Recurrent stroke within three months occurred in 1.1% of patients.
The authors said stronger control of hypertension and diabetes, tobacco cessation, faster referral systems and better access to acute stroke care — particularly in rural India — were critical. Without improvements in prevention and rapid response, stroke would continue to strike early and leave families coping with avoidable disability.
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