Disparities in Awareness of Myocardial Infarction and Stroke Symptoms and Response Among United States– and Foreign‐Born Adults in the National Health Interview Survey

Abstract

Background Atherosclerotic cardiovascular disease, defined as nonfatal myocardial infarction (MI), coronary heart disease death, or fatal or nonfatal stroke, is the leading cause of death in the United States. MI and stroke symptom awareness and response reduce delays in hospitalization and mortality. Methods and Results We analyzed cross‐sectional data from the 2014 and 2017 National Health Interview Surveys on US‐ and foreign‐born adults from 9 regions of birth (Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, Indian subcontinent, Asia, and Southeast Asia). The outcomes were recommended MI and stroke knowledge, defined as knowing all 5 symptoms of MI or stroke, respectively, and choosing “call 9‐1‐1” as the best response. We included 63 059 participants, with a mean age 49.4 years; 54.1% were women, and 38.5% had a high school education or less. Recommended MI and stroke knowledge were highest in US‐born people. In both 2014 and 2017, MI knowledge was lowest in individuals born in Asia (23.9%±2.5% and 32.1%±3.3%, respectively), and stroke knowledge lowest for the Indian subcontinent (44.4%±2.4% and 46.0%±3.2%, respectively). Among foreign‐born adults, people from Russia and Europe had the highest prevalence of recommended MI knowledge in 2014 (37.4%±5.4%) and 2017 (43.5%±2.5%), respectively, and recommended stroke knowledge was highest in people from Europe (61.0%±2.6% and 67.2%±2.5%). Improvement in knowledge was not significant in all groups between 2014 and 2017. Conclusions These findings suggest a disparity in MI and stroke symptom awareness and response among immigrants in the United States. Culturally tailored public health education and health literacy initiatives are needed to help reduce these disparities in awareness.

Knowledge, Attitudes, and Practices Regarding Stroke in Multicultural Communities: Should the Indonesian Government Reconsider Stroke Awareness Campaigns?

“…This finding is in line with several other studies on stroke awareness that reported that the higher the level of education, the higher the level of knowledge (1,19). It is accepted that people with higher levels of education have the ability to digest information material better than people with lower levels of education (20). This study also revealed that not only ethnicity and education, but also the place where respondents live are able to determine their knowledge of stroke awareness.…”

“…This kind of thing becomes ineffective because it is carried out uniformly and on a national scale, while in this study we found that apart from monthly income, notably, ethnicity is a very important factor in determining the stroke awareness profile of the community. This finding is echoed by at least two other studies conducted on 4 main ethnic groups in New Zealand and on US-and foreign-born individuals in the United States, they all reported a high contribution of ethnic identity in determining a person's stroke awareness profile (10,20). Furthermore, respondents with income above the minimum wage have much better practices than respondents who earn below the minimum wage, it is also supported by a similar finding that was also reported by a study conducted in Egypt (1).…”

Differences in Myocardial Infarction and Stroke Knowledge and Awareness Among US‐ and Foreign‐Born Individuals: Potential Causes and Implications

“…In this issue of the Journal of the American Heart Association (JAHA) , Mannoh et al examined disparities in awareness of myocardial infarction (MI) and stroke symptoms among US‐ and foreign‐born adults. Their most important finding, that there are differences in awareness of MI and stroke symptoms by region of birth, 1 confirms and expands upon prior research 2 in several ways.…”

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

“…63 Compared with adults born in the United States, adults born in Europe, Russia, Africa, Middle East, Indian subcontinent, Asia, and Southeast Asia were likely to be aware of all 5 MI symptoms in the NHIS 2017 cycle. 64…”