A new study from the University of Washington has found a quarter of the global population over age 25 will experience a stroke at some point in their lives.

“Our findings are startling,” says senior author on the study, Dr. Gregory Roth, an assistant professor of health metrics sciences at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. “We found extremely high lifetime risk for stroke, and based on other research we evaluated, it is clear that younger adults need to think about long-term health risks. They can make a real difference by eating healthier diets, exercising regularly, and avoiding tobacco and alcohol.”

The study analyzed data from 195 countries, from 1990 to 2016, finding China, where 2 in 5 men and women will experience a stroke at any point in their lifetime beyond age 25, as well as countries in East Asia, Central and Eastern Europe (all 1 in 3 risks or higher) driving the global burden of stroke. By contrast, the lifetime risk of stroke for India’s young adults stands at 11 to 17%.

However, Roth says, that doesn’t mean Indian youth are healthier or receive better preventative care than their global peers. “On the contrary, people [in countries with lower stroke risk] are merely at higher risk of dying of another cause first,” he says.

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Published in The New England Journal of Medicine, scientists used estimates from the Global Burden of Disease study (GBD) to measure the combined risk of having a stroke and surviving, with suffering a stroke and dying. 

Strokes among adults can be caused by a variety of factors, and study authors say these new statistics should encourage doctors and institutions to discuss the importance of lifestyle changes with young patients, to lower their lifetime risk. The study authors also urge policymakers to develop programs that encourage young people to eat healthier diets with more fruits, vegetables, and whole grains, and advocate for the lower prices of medications that help control high blood pressure and cholesterol.