Gender differences among young adults with ischemic strokes were analyzed and it was found that in comparison to men, 44% more women ≤35 years had ischemic strokes. This gap reduces in young adults, 35 to 45 years, and there exists conflicting evidence if more men or women experience ischemic strokes in the 35 to 45 age group.

• This systematic review included 19 original studies that were population based and documented stroke incidence by gender or gender-specific incidence rate ratios of young adults ≤45 years.

• In 9 studies, no statistically significant gender difference was found among young adults ≤45 years.

• Among young adults ≥30 to 35 years, higher rates of ischemic stroke were found among men, in three studies.

• In four studies, there were more women with ischemic strokes among young adults ≤35 years.

• Estimated effect size, in young adults ≤35 years, favored more ischemic strokes in females (incidence rate ratio, 1.44) and a nonsignificant gender difference in young adults 35 to 45 years (incidence rate ratio, 1.08).