Victor J. Del Brutto, MD

Mszar R, Mahajan S, Valero-Elizondo J, Yahya T, Sharma R, Grandhi GR, Khera R, Virani SS, Lichtman J, Khan Su, et al. Association Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults. Stroke. 2020.

Stroke is a devastating disease with potentially catastrophic consequences to its victims and their families. In the acute setting, immediate specialized evaluation and rapid delivery of time-sensitive therapies are crucial to improve the chances of a meaningful neurological recovery. Stroke systems of care across the world work daily in maximizing their treatment times in order to save neurons. However, time from symptoms onset to hospital arrival mainly depends on community awareness of stroke warning signs and the emergent response to stroke-like symptoms when they are perceived.

The World Stroke Day observed annually on October 29 was launched in 2006 with the main goal of raising awareness of the prevention and treatment of stroke. Mszar and colleagues bring us a timely analysis on the association between sociodemographic characteristics and disparities in awareness of stroke symptoms among U.S. young adults, a population group that has shown increasing trends in stroke incidence and stroke-related hospitalizations during the last few decades.

Using data from the 2017 National Health Survey, investigators evaluated stroke awareness in young adults by assessing familiarity with five cardinal stroke symptoms and the type of response to perceived stroke. The authors found that across 9,441 surveyed young adults (aged <45 years), 28.9% were unaware of all five stroke symptoms and 2.7% were unaware of any stroke symptom at all. By applying national prevalence estimates, the latter translates into 31 million U.S. young adults with limited notion about stroke symptoms and 2.9 million U.S. young adults unaware of any stroke symptom. Young adults were less likely to be aware of stroke symptomatology when compared to older populations. In addition, a considerable fraction of young adults (2.7%) would elect not to contact EMS in response to perceived stroke symptoms.

Sociodemographic characteristics associated with lack of stroke awareness in young adults were being Black or Hispanic, being born outside the U.S., having a lower income, having a lower level of education, and being uninsured. Only 50% of young individuals with all of these characteristics were aware of all five stroke symptoms. In adjusted analysis, the single strongest sociodemographic characteristic associated with incomplete stroke symptoms awareness was lower education level (OR=2.8; 95%CI 1.8-4.4).

The current study addresses the urgent need to disseminate stroke education among the young. Moreover, it supports previous observations that vulnerable populations are less likely to receive appropriate stroke care. The authors emphasize the necessity of public educational campaigns designed to overcome cultural barriers, societal stigmas, and economic limitations. World Stroke Day is a great opportunity for vascular neurologists to send out the message to the community that recognizing the signs of stroke early can significantly reduce its impact. Despite the need for limiting interindividual contact due to the ongoing global pandemic, suspected stroke is a situation in which we have to stress #DontStayAtHome.