People at high risk of stroke less aware of stroke warning signs

People at the highest risk of having a stroke ? the elderly and those who have had a previous stroke ? are less likely to know the five warning signs of stroke, according to research presented at the American Stroke Association’s International Stroke Conference 2009.

Researchers also found that:

  • People with lower income and less education are less aware of stroke symptoms than those who earn more money and are more educated.
  • Women and whites were significantly more knowledgeable about stroke symptoms and more often knew to call 9-1-1 immediately.

“We have to make sure that people know the signs and symptoms of stroke because the patient would need to get to the hospital as soon as possible to have a much higher chance of survival and avoiding potential disabilities,” said Jing Fang, M.D., the study’s lead author.

For the study, researchers used the U.S. Centers for Disease Control and Prevention’s (CDC) 2007 Behavioral Risk Factor Surveillance System (BRFSS), which is the world’s largest ongoing telephone health survey. The BRFSS has been tracking health information in the United States every year since 1984. This study included responses from 86,573 adults from 11 states, the District of Columbia and the Virgin Islands.

In addition, five stroke-specific questions were asked to determine if respondents knew stroke symptoms and what to do if someone is having a stroke.

“We were really surprised to see people who have had a stroke were less aware of symptoms than those who had not had a stroke,” said Fang, an epidemiologist in the Division for Heart Disease and Stroke Prevention at the CDC in Atlanta.

The survey also found that some people were aware of certain symptoms but not others.

For example, 93 percent of those polled knew a warning sign of stroke was sudden weakness in the face, arm or leg, particularly if the weakness occurs on only one side of the body. However,
only 59 percent identified a sudden severe headache with no known cause as a stroke warning symptom.

The other warning signs of stroke are:

  • sudden vision disturbance in one or both eyes;
  • sudden confusion or difficulty speaking; and/or
  • sudden dizziness, loss of balance, loss of coordination or difficulty walking.

Only 37 percent of respondents knew all five warning signs and knew to call 9-1-1 immediately.

The survey also showed that people over 65 years old were less knowledgeable about stroke symptoms than those ages 45 to 65, who were more likely to know the warning signs than all other age groups.

“From a public health point of view, we have to do a more aggressive educational campaign to target the older population,” Fang said.

Race, education, income, gender and even marital status also played a large role in determining which people could correctly spot the stroke warning signs and knew to call 9-1-1.

  • For race, 40 percent of whites knew the information compared to 31 percent of blacks and 21 percent of Hispanics.
  • Of those with at least a college education, 46 percent correctly identified the information, compared to 19 percent of people with less than a high school education.
  • For income, 45 percent of those earning more than $50,000 per year knew the information, while 28 percent of those who earned less than $25,000 did.
  • Thirty-four percent of men knew the information compared to 40 percent of women.
  • Married respondents knew the warning symptoms and what to do at a higher rate ? 40 percent compared to 32 percent ? than those who were unmarried.

Primary care doctors and other physicians should ensure that their patients understand what a stroke might look like, Fang said. “Doctors should give more educational materials. We found a big disparity in age, gender, race, income and education. If we want to improve awareness, we should be more focused on those populations who were less aware of the signs.”


Co-authors: are Nora L. Keenan, Ph.D., and Carma Ayala, Ph.D. Individual author disclosures can be found on the abstract.

The U.S. Centers for Disease Control and Prevention funded the study.

Editor’s note: The American Academy of Neurology, the American College of Emergency Physicians, and the American Heart Association/American Stroke Association have created Give ME 5 for Stroke, a campaign offering an easy way to remember the stroke warning signs. For more information, visit: giveme5forstroke.org.

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