Awareness of Stroke Signs and Symptoms and Calling 9-1-1 Among US Adults: National Health Interview Survey, 2009 and 2014

Abstract

Introduction: Early recognition of stroke symptoms and recognizing the importance of calling 9-1-1 improves the timeliness of appropriate emergency care, resulting in improved health outcomes. The objective of this study was to assess changes in awareness of stroke symptoms and calling 9-1-1 from 2009 to 2014.

Methods: We analyzed data among 27,211 adults from 2009 and 35,862 adults from 2014 using the National Health Interview Survey (NHIS). The NHIS included 5 questions in both 2009 and 2014 about stroke signs and symptoms and one about the first action to take when someone is having a stroke. We estimated the prevalence of awareness of each symptom, all 5 symptoms, the importance of calling 9-1-1, and knowledge of all 5 symptoms plus the importance of calling 9-1-1 (indicating recommended stroke knowledge). We assessed changes from 2009 to 2014 in the prevalence of awareness. Data analyses were conducted in 2016.

Results: In 2014, awareness of stroke symptoms ranged from 76.1% (sudden severe headache) to 93.7% (numbness of face, arm, leg, side); 68.3% of respondents recognized all 5 symptoms, and 66.2% were aware of all recommended stroke knowledge. After adjusting for sex, age, educational attainment, and race/ethnicity, logistic regression results showed a significant absolute increase of 14.7 percentage points in recommended stroke knowledge from 2009 (51.5%) to 2014 (66.2%). Among US adults, recommended stroke knowledge increased from 2009 to 2014.

Conclusion: Stroke awareness among US adults has improved but remains suboptimal.

Figure 1

Prevalence of stroke symptom awareness, National Health Interview Survey, 2009 and 2014. Stroke symptom awareness was assessed with the question, “Which of the following would you say are the symptoms that someone may be having a stroke?” Response options were numbness of face, arm, leg, or side; confusion or trouble speaking; sudden trouble seeing; trouble walking; and sudden severe headache. Analyses were conducted using t test for difference in prevalence from 2009 to 2014 and adjusted for sex, age, race/ethnicity, and education.

Figure 2

Prevalence of knowledge of Healthy People 2020 heart disease and stroke objectives 17.1–17.3, National Health Interview Survey, 2009 and 2014. Knowledge of all 5 stroke symptoms (ie, numbness of face, arm, leg, or side; confusion or trouble speaking; sudden trouble seeing; trouble walking; and sudden severe headache) was assessed with the question, “Which of the following would you say are the symptoms that someone may be having a stroke?” Awareness of the importance of calling 911 was assessed with the question, “If you thought someone was having a stroke, what is the best thing to do right away?” Participants were defined as aware if they answered, “Call 911 or other emergency number.” Recommended stroke knowledge was defined as correct identification of all 5 stroke symptoms and knowing the importance of calling 911 or other emergency number. Analyses were conducted using t test for difference in prevalence from 2009 to 2014 and adjusted for sex, age, race/ethnicity, and education.