At a time when stroke is increasing among young adults, almost 30% of American adults under the age of 45 do not know all five of the most common stroke symptoms, according to new research published today in Leakage, a newspaper of the American Stroke Association, a division of the American Heart Association.
Stroke is the 5th leading cause of death and a leading cause of disability in the United States. Each year, 10% to 15% of the nearly 795,000 people in the United States who have a stroke are young adults – ages 18 to 45. Recent studies suggest that the incidence of stroke is decreasing in the general population, but the incidence of stroke and hospitalizations has increased by more than 40% in young adults in recent decades.
“Although the medical community has made significant improvements to reduce the severity and complications of strokes with early interventions, these efforts are of limited value if patients do not recognize the symptoms of the stroke,” said study author Khurram Nasir, MD, MPH , M.Sc., head of the cardiovascular prevention and wellness division at the Houston Methodist DeBakey Heart and Vascular Center in Houston, Texas. “Time is critical for treating stroke. The sooner people recognize the symptoms, the better their chances of reducing the long-term disability caused by the stroke.”
To assess how well the U.S. population understands common stroke symptoms, Nasir and colleagues reviewed responses to the 2017 National Health Interview Survey. As part of the annual survey, adults answer several questions about stroke, including identification of five of the most common stroke symptoms, which in this research were noted as:
- Numbness of the face / arm / leg;
Confusion / difficulty in speaking;
Difficulty walking / dizziness / loss of balance;
Problems seeing in one / both eyes; and
In a targeted subset of the full survey, the researchers analyzed the responses of 9,844 young adults, under the age of 45, which statistically represents 107.2 million young adults in the US population. The average age of the youngest respondents was 31, half were women and 62.2% were non-Hispanic whites.
The researchers found:
Almost one in three (28.9%) interviewed was unaware of all five common stroke symptoms.
About 3% of respondents, representing almost 3 million young adults, were unaware of any stroke symptoms.
Hispanic adults and adults who were not born in the United States are twice as likely to miss any of the common stroke symptoms as compared to non-Hispanic white people born in the United States
Young adults with a high school diploma or a lower level of education were almost three times more likely to miss any stroke symptoms, compared to young adults with higher levels of education
Nasir said that the high number of young adults who remain unaware of the symptoms of stroke is surprising and, along with the continuing social inequalities, these are the main concerns.
“With the increasing risk of stroke among young adults in the United States, our study sheds light on particularly vulnerable individuals and communities who already face a disproportionately greater burden of stroke and cardiovascular risk factors, as well as reduced access to health services” , he said. “We hope that highlighting the continuing impact of current health disparities can promote focused public health strategies and educational initiatives to increase awareness and the appropriate response to stroke symptoms.”
The researchers also found that almost 3% of young adults surveyed would not contact emergency medical services if they saw someone with symptoms of a stroke. “This discovery could be a matter of life and death,” said Mitchell SV Elkind, MD, MS, FAHA, FAAN, president of the American Heart Association.
“With proper and timely medical attention, a stroke is largely treatable. The faster you are treated, the more likely you are to minimize the long-term effects of a stroke and even prevent death,” said Elkind, professor of neurology and epidemiology at Vagelos College of Physicians and Surgeons and assistant neurologist at the Irving Medical Center at New York-Presbyterian / Columbia University in New York City. “Calling 9-1-1 is critical because trained EMS personnel can initiate the care protocol on the way to the hospital and have specialized teams ready at the hospital to administer the most appropriate treatment immediately.”
Elkind says the American Heart Association / American Stroke Association advocates using the letters in “FAST” to detect signs of stroke and to know when to call 9-1-1:
- Fallen face
It’s time to call 9-1-1
Nasir said that FAST is among a series of creative and community-driven initiatives that aim to increase public recognition of common stroke symptoms, and he emphasizes the urgency of addressing contemporary health inequalities head-on through personalized public health approaches and multidisciplinary.
“Our results show that new strategies are needed at the population level to increase symptom awareness among young adults, where we find a high-risk population with substantial variations in symptom recognition,” he said.
A possible limitation of the study is that respondents answered “yes” or “no” when asked if something was a common stroke symptom. This could lead to an overestimation of real rates of awareness, according to the authors.