Factors Influencing Unawareness of Warning Signs of Stroke among Hypertensive Diabetic Patients at a High Risk for Stroke: The 2017 Nationwide Community Health Survey in Korea

Abstract

The purpose of this study was to assess the awareness of warning signs of stroke and identify the risk factors influencing such awareness among diabetics with hypertension who are at a high risk for stroke. Methods: Data from the 2017 Korea Community Health Survey were used. A total of 15,536 adults older than 30 years diagnosed with hypertension and diabetes mellitus were included in the final analysis. Data were analyzed using frequency, percentage, x 2 test, and logistic regression with SPSS/WIN 24.0 program. Results: Among the five warning signs of stroke, "sudden trouble in speaking or understanding" (79.0%) was the most commonly identified one and "sudden severe headache with an unknown cause" (65.2%) was the least. Only 48.8% participants identified all five warning signs and 11.8% could not identify any of them. In the logistic regression model, the risk of unawareness of warning signs of stroke was significantly higher among those aged 30~49 years and 70 years or older, with a lower educational level, without a spouse, and with a heavy alcohol consumption and current smoking status. Conclusion: The level of awareness of warning signs was low in hypertensive diabetic adults. To improve awareness of warning signs of stroke, a customized educational program should be provided to hypertensive diabetic adults considering the risk factors relevant to unawareness of warning signs of stroke. The education on warning signs of stroke can potentially lead to a reduction in morbidity in the survivors.

Blood Pressure Awareness and Knowledge of Cardio-Cerebrovascular Diseases in South Korean Women with Hypertension

“…Although a direct comparison is difficult, 11.8% and 48.8% of diabetes patients with HTN were not aware of any warning signs and were aware of all signs, respectively, similar to our study. Also, a severe headache with no known cause and sudden trouble seeing in one or both eyes had the lowest awareness level as a warning sign of a stroke in our study, similar to other studies [ 16 , 17 , 19 , 41 ]. Stroke symptoms experienced by hospitalized patients include dizziness, dysarthria/slurred speech, hemiplegia, general weakness, facial paralysis, and consciousness disturbance, along with less common symptoms such as headache, nausea/vomiting, and convulsion [ 45 , 46 ].…”

“…Patients do not experience all symptoms during a heart attack and may complain of syncope, weakness [ 12 , 13 , 43 ], or arm and shoulder pain or discomfort [ 44 ]. In particular, women reported milder symptoms [ 1 ] and complained more about back pain and shoulder blade pain or discomfort [ 17 , 44 ]. Also, atypical symptoms such as abdominal discomfort, fatigue, cough, fever, and nausea/vomiting were observed [ 1 , 12 , 13 , 43 ].…”

“…To minimize complications and reduce mortality rates due to CVDs, prompt and appropriate treatment should be administered, and it is important to know CVDs’ warning signs. However, previous studies showed that less than half the people (15.6% to 48.8%) were aware of all the warning symptoms [ 15 , 16 , 17 , 18 ]. As mentioned above, women are more prone to lack recognition of knowledge of CVDs warning signs (KCVDs) because of experiencing atypical symptoms; this was reported as the cause of increased treatment delay among women [ 12 , 13 ].…”

“…The factors associated with KCVDs were age, residence, marital status, education level, income, smoking, alcohol consumption, body mass index (BMI)/obesity, comorbidities such as DM, (family) history of CVDs, and exercise [ 1 , 2 , 8 , 15 , 17 , 18 , 19 ]. Concerning mental health, health-related quality of life (HRQoL), depression, and subjective health status are associated with HTN [ 20 , 21 , 22 ].…”

“…To the best of our knowledge, no study has been conducted on this issue in South Korea. In addition, some studies have reported the awareness of CVD warning signs using the Korean Community Health Survey (KCHS) data [ 17 , 18 , 19 , 26 ]; however, no study has investigated the warning signs of heart attack as well as stroke, while targeting women with HTN, as one of the risk factors of CVDs. Therefore, this study aimed to evaluate the level of KCVDs, according to AoBP, in women with HTN, and the associated factors with KCVDs and AoBP.…”