Kevin O’Connor, 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;51:3552-3561.

Although the majority of U.S. adults know at least some stroke symptoms, awareness is lower among the younger population (i.e., age 18 to 44 years) and in various sociodemographic subgroups. The 2017 National Health Interview Survey assessed the participants’ (n=26,742) awareness of five sets of stroke symptoms: “(1) sudden numbness or weakness of the face, arm, or leg, especially on one side; (2) sudden confusion or trouble speaking; (3) sudden trouble seeing in one or both eyes; (4) sudden trouble walking, dizziness, or loss of balance; and (5) sudden severe headache with no known cause.” Mszar et al. compared survey responses to evaluate knowledge of stroke symptoms and understanding of the importance of contacting EMS for stroke symptoms.

Among 9,844 adults age < 45-years (39.7%), 7,126 (71.1% [95% CI, 69.6–72.5]) identified all five stroke symptoms. The most infrequently identified stroke symptom was severe headache (n=7,709 [77.5%; 95% CI, 76.3–78.7]), and 242 were unable to identify any stroke symptoms (2.7% [95% CI, 2.2–3.3]). Adults 45-64 (n=6,477 [76.0%; 95% CI, 74.8–77.3]) and those age 65+ (n=5,044 [77.9%; 95% CI, 76.5–79.3]) had greater awareness of stroke symptoms. Hispanic ethnicity (OR, 1.96 [95% CI, 1.17–3.28]), non-U.S. born immigration status (OR, 2.02 [95% CI, 1.31–3.11]), and lower education level (OR, 2.77 [95% CI, 1.76–4.35]) were associated with lack of awareness of any stroke symptoms among young adults.

Five sociodemographic factors were identified as high-risk for limited awareness. Young adults with an increasing burden of high-risk characteristics (non-White, non-U.S. born, low income, uninsured, and high school or lower educated) had an associated stepwise decrease in stroke symptom awareness and a stepwise increase in the likelihood of not being aware of all five symptoms. Respondents with all five characteristics (n=106, 48.3% [95% CI, 37.9–58.9]) were more likely to be unaware of any of the five stroke symptoms than young adults with no high-risk factors (n=2,458, 20.6% [95% CI, 19.0–22.4]). Young adults with one (OR, 1.35 [95% CI, 1.17–1.56]), three (OR, 2.65 [95% CI, 2.16–3.25]), and five (OR, 3.70 [95% CI, 2.43–5.62]) high-risk characteristics were increasingly likely to lack awareness of all five symptoms. 

A slightly larger proportion of young adults (n=246, 2.7% [95% CI, 2.3–3.2]) would not contact EMS in response to stroke symptoms compared to adults 65+ (n=241, 3.9% [95% CI, 3.4–4.5]); middle age adults were similar (n=215, 2.7% [95% CI, 2.2–3.2]). In a weighted analysis, high-risk characteristics were associated with increased likelihood of not contacting EMS. This was most prominent among individuals born outside the U.S. (n=81, 4.71% [95% CI, 3.56-6.21] versus n=165, 2.24% [95% CI, 1.82-2.77]), uninsured (n=61, 4.86% [95% CI, 3.63=6.48] versus n=139 [private insurance], 2.3% [95% CI, 1.84-2.88] and n=46 [public insurance], 2.58% [95% CI, 1.77-3.74]), and young adults with lower income (n=109, 3.6% [95% CI, 2.85-4.53] versus n=126, 2.18% [95% CI, 1.75-2.71]).

These results could be used to tailor ongoing stroke education initiatives to help recognize and mitigate healthcare disparities. Additional studies to identify high-risk geographical determinants and other sociodemographic characteristics may help to further target educational interventions.