Multiple Causes of Death Associated With Stroke in Young Adults Aged 20-49 Years in Brazil: A Population-Based Time-Series Analysis From 2015 to 2024

Introduction: Stroke mortality has been rising among young adults, and restricting analysis to the underlying cause of death simplifies the sequence of coexisting conditions that culminate in a fatal outcome.This study aimed to analyze mortality from underlying and multiple causes of death associated with stroke among young adults (20-49 years) in Brazil between 2015 and 2024.Methods: This retrospective, population-based time-series study analyzed individual-level death certificate data for residents of Brazil of both sexes aged 20 to 49 years, recorded in the National Mortality Information System/Department of Informatics of the Brazilian Unified Health System (SIM/DATASUS) between 2015 and 2024.Stroke deaths were identified using ICD-10 codes I60-I69.Temporal trends were assessed using Prais-Winsten regression.Results: Of 2,187,873 deaths recorded during the period, 71,349 (3.26%) had stroke as the underlying cause.Hemorrhagic stroke predominated (n = 38,447; 53.9%) over ischemic stroke (n = 4,719; 6.6%).Proportional mortality was higher among females (n = 34,047; 5.20%) than males (n = 37,296; 2.43%).The temporal trend was stationary (annual percent change = -0.85%;p = 0.536), with a transient decline during the coronavirus disease 2019 (COVID-19) pandemic.Hypertension was the main recorded comorbidity (n = 21,926; 30.7%).Alcohol use was nearly four times more frequent among men (prevalence ratio (PR) = 3.83).Most deaths occurred in hospital settings (n = 64,134; 89.9%), frequently associated with complications such as sepsis and cerebral edema.Conclusions: Hemorrhagic stroke is the leading cause of cerebrovascular death among young Brazilian adults, strongly linked to hypertension.These findings highlight the complexity of multiple causes of death and the need to strengthen primary prevention and control of modifiable risk factors, alongside improved hospital care to reduce premature mortality in this population.