How Many U.S. Adults Know the Signs of a Stroke? (2017)

This report uses survey data from 2017. Targets it mentions, such as those of Healthy People 2020 and Million Hearts, were the ones in place then.

Stroke was the fifth leading cause of death in the United States, and in 2017 someone died of a stroke every 3 minutes and 35 seconds on average. It is also a leading cause of long-term disability. Preventing death and disability depends on recognizing a stroke quickly and getting medical care early.

The common warning signs of a stroke are sudden:

• numbness or weakness of the face, arm or leg, especially on one side;
• confusion or trouble speaking;
• trouble seeing in one or both eyes;
• trouble walking, dizziness or loss of balance;
• severe headache with no known cause.

At the first sign of a suspected stroke, the right thing to do is call 9-1-1. Public campaigns have stressed both messages, and stroke knowledge rose 14.7 percentage points from 2009 to 2014. CDC researchers used the 2017 National Health Interview Survey (NHIS) to see where knowledge stood.

The survey

The 2017 NHIS asked 26,076 adults aged 20 and older whether each of the five signs was a sign "that someone may be having a stroke," and what was "the best thing to do right away" if they thought someone was having one. The choices were to advise the person to drive to the hospital, advise them to call their doctor, call 9-1-1 or another emergency number, call a spouse or family member, or something else. Knowing all five signs and to call 9-1-1 was counted as "recommended stroke knowledge."

What people knew

That overall figure was in line with the 66.2% reported for 2014.

Who knew less

Recommended stroke knowledge differed significantly by race and Hispanic origin: 71.3% of non-Hispanic white adults, 64.0% of non-Hispanic Black adults and 57.8% of Hispanic adults. It rose with education, from 54.8% among adults without a high school diploma to 73.1% among college graduates. It also differed, less sharply, by sex, age, urban or rural county, and region. After adjusting for the other factors, the gaps by race and Hispanic origin and by education persisted.

Headache was the least recognized sign. That may be partly because it came last in the questionnaire, or because headache accompanies so many conditions. Campaigns may also underplay it: some use shortened acronyms such as BE-FAST (balance, eyes, face, arms, speech, time), which leaves headache out.

Why it matters

Healthy People 2020 set goals of 59.3% for awareness of common stroke signs and 94.7% for knowing to call 9-1-1, measured with age adjustment. The estimates in this report were not age-adjusted, but they suggest those goals may have been exceeded nationally and regionally.

Stroke illness and death fall hardest on racial and ethnic minority groups, people with less education, and people in the Southeast's "stroke belt." In some groups stroke deaths may be rising, and in most states the long decline in stroke death rates has stalled. How much better stroke knowledge could change those trends is unknown.

Calling 9-1-1 quickly raises the chance that a person having an ischemic stroke will get tissue plasminogen activator (tPA) in time to benefit. Programs working on the chain of care include CDC's Paul Coverdell National Acute Stroke Program, the U.S. Department of Health and Human Services' Million Hearts initiative, which aimed to prevent 1 million heart attacks and strokes by 2022, and the American Heart Association and American Stroke Association's Get With The Guidelines–Stroke program. The authors call for focused public health work, community engagement and tailored messages to close the gaps.

Limits

Answers were self-reported and may be affected by memory or by the wish to give the expected answer. The questions did not cover every possible sign, and yes-or-no questions may overstate awareness. There is no standard for judging stroke awareness or how knowledge turns into action, and with so large a sample even small differences can be statistically significant without being meaningful.

Sources

• Jackson SL, Legvold B, Vahratian A, et al. Sociodemographic and Geographic Variation in Awareness of Stroke Signs and Symptoms Among Adults — United States, 2017. MMWR Morb Mortal Wkly Rep 69(44). https://www.cdc.gov/mmwr/volumes/69/wr/mm6944a1.htm