Only 16.4 percent of nearly 72,000 people surveyed in 13 states and Washington, DC, recognized all five warning symptoms of stroke, an incorrect symptom, and the need to call 911 immediately in the event of a stroke. In addition, there were marked differences in awareness about stroke symptoms by demographics, race and ethnicity, gender, and education.
These and other statistics were reported in an analysis of data from the 2005 Behavioral Risk Factor Surveillance System heart and stroke survey in the May 9 Morbidity and Mortality Weekly Report by the Centers for Disease Control and Prevention (CDC). The report was published in the July 19 Journal of the American Medical Association.
In general, 43.6 percent of individuals recognized all five correct stroke warning signs; 18.6 percent knew all symptoms and that sudden chest pain is not a stroke symptom; and 38.1 percent were aware of all symptoms and would first call 911 if someone were having a stroke.
Awareness of all five warning symptoms and calling 911 was higher among whites (41.3 percent), people with a college degree or higher (47.6 percent), and women (41.5 percent), compared to African-Americans (29.5 percent) and Hispanics (26.8 percent), people who did not have a high school diploma (22.5 percent), and men (34.5 percent).
Jeffrey A. Switzer, DO, assistant professor of vascular neurology at the Medical College of Georgia, noted that the 2001 National Health Interview Survey estimated that 78 percent of the respondents recognized all five stroke warning symptoms. However, he said, the discrepancy may be related to the fact that the 2005 survey included only households with landline phones in 13 states and DC, and “more young people now use only cell phones and therefore would not have been contacted by the 2005 study.
“This could have biased the current study to an older sample of the population, which may have been different than that of 2001,” he added.
Additionally, the structure of the questions was different; the 2005 survey included incorrect symptoms, which were not used in 2001.
“It all depends on how you ask the question: if you give people lists they do much better, but if you ask them to independently generate answers (their own knowledge), the numbers are much lower,” said Dawn Kleindorfer, MD, director of the Stroke Prevention Research Program at the University of Cincinnati College of Medicine.
Awareness efforts need to be particularly targeted towards men, Hispanics, African-Americans, and those with less education — such as providing education in foreign languages to assist non-English speakers, the report noted. More research needs to be done to determine the best message about stroke warning signs and its ideal form of delivery, said Dr. Switzer, because that could be different in various communities.
Marilyn M. Rymer, MD, medical director of the Saint Luke's Brain and Stroke Institute in Kansas City, MO, and professor of medicine at the University of Missouri-Kansas City (UMKC) School of Medicine, School of Medicine, said public health efforts should also focus on the least known symptoms (severe headache with no known cause and sudden vision loss in one or both eyes).•
CDC. Awareness of Stroke Warning Symptoms — 13 States and the District of Columbia, 2005. MMWR 2008;57(18):481–485.