According to research published today, younger Americans are increasingly dealing with a health problem that was less common in past generations.

Scientists at the University of Cincinnati examined data from a population study of residents in the area dating back decades. Compared to the early 1990s, the stroke rate among adults under 55 has substantially risen over time, they found. More research into the factors contributing to this rise in early strokes is urgently needed, the researchers say.

“We don’t know for sure why strokes are becoming more common, and we really need to understand why if we are going to reverse this trend,” study author David Robinson, a neurologist and rehabilitation specialist at the University of Cincinnati’s College of Medicine, told Gizmodo.

People today in the U.S. and other countries are significantly less likely to die from strokes and other cardiovascular diseases than in the past. While some of this success is due to advances in medicine, the overall incidence of strokes has also genuinely declined over time. This decline hasn’t been evenly spread, though. Numerous studies have suggested that while older adults are having strokes less often, this isn’t the case for people under 50 lately.

While research looking at death certificates has suggested that younger people are dying from strokes more often, these studies have their issues, Robinson says—namely that an increase in reported stroke-related deaths isn’t necessarily because strokes are becoming more common (perhaps it could reflect a change in how doctors are filling out death certificates, for instance).

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