Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3021 — Racial/Ethnic Differences in Stroke Awareness among Veterans

Ellis C (Charleston TREP) , Egede LE (Charleston TREP)

Objectives:
To examine racial/ethnic differences in recognition of stroke warning signs/symptoms and action to initiate treatment after stroke among veterans.

Methods:
Data on 36,150 veterans from the 2003 Behavioral Risk Factor Surveillance System (BRFSS) were examined. Recognition of warning signs/symptoms of stroke including (1) sudden numbness or weakness of the face or leg, (2) sudden confusion, trouble speaking or understanding, (3) sudden trouble seeing in one or both eyes, (4) sudden trouble walking, dizziness, loss of balance or coordination, and (5) sudden severe headache with no known cause were compared by race/ethnicity. Recognition of all 5 signs/symptoms and appropriate first action to call 9-1-1 were compared by race/ethnicity. Multiple logistic regression was used to determine racial/ethnic differences in stroke recognition and appropriate first action controlling for relevant covariates. STATA was used for analyses to control for complex survey design of BRFSS.

Results:
96% recognized sudden confusion, 97% recognized sudden facial numbness, 94% recognized sudden trouble walking, 88% recognized sudden vision loss, and 80% recognized sudden headache as warning signs/symptoms of stroke; and 88% said they would call 9-1-1 if someone was having a stroke. Only 17% recognized all 5 symptoms and only 15% recognized all 5 symptoms and would call 9-1-1 as first action. In multivariate models with Whites as reference, Blacks were less likely to recognize sudden vision loss (OR 0.55, [0.39-0.77]). Hispanics (OR 0.34, [0.22-0.51]) and “Others” (OR 0.68, [0.50-0.92]) were less likely to recognize all 5 symptoms, and Hispanics (OR 0.37, [0.24-0.58]) and “Others” (OR 0.68, [0.48-0.96]) were less likely to recognize all 5 symptoms and call 9-1-1 as first action.

Implications:
Few veterans recognize all 5 warning signs/symptoms of stroke. Race/ethnicity is not associated with recognition of individual warning signs/symptoms of stroke; however, ethnic minorities are less likely to recognize all 5 signs/symptoms and take appropriate action.

Impacts:
Poor recognition of multiple symptoms of stroke and appropriate actions in the event of a stroke may contribute to reported delays in seeking treatment and poorer stroke outcomes among minority veterans. VHA educational efforts should focus on increasing awareness of multiple presentations of stroke and appropriate actions, especially among ethnic minorities.