Georgia stroke and heart attack awareness survey

2006 GEORGIA STROKE AND HEART ATTACK AWARENESS SURVEY

Introduction

Cardiovascular disease (CVD) is the leading cause of death in Georgia, accounting for one third (32%) of deaths in 2006. Georgia's CVD death rate is 9% higher than the U.S. average. In 2006, approximately 143,800 hospitalizations occurred due to CVD among Georgia residents, with an average charge of $30,700 per hospitalization. Total hospital charges for CVD in Georgia were $4.4 billion. The overall cost of CVD in Georgia is estimated to be $10.5 billion. This includes direct health care costs and lost productivity from illness and death (indirect costs).1 Stroke is the third leading cause of death in Georgia, accounting for 6% of all deaths. In 2006, Georgia's stroke death rate was 16% higher than the national rate.

Significant disparities exist for CVD in Georgia. Death rates for men are 1.4 times higher than for women, and are 1.3 times higher for blacks than for whites. Black males are at particularly high risk for premature death due to CVD: nearly half of those who died from CVD in 2006 were younger than 65. Many Georgians also place themselves at higher risk for CVD by not modifying their risk factors, which include high blood pressure, high cholesterol, overweight/obesity, sedentary lifestyle, smoking, diabetes, and poor diet.

Stroke and heart attack are life-threatening conditions. If you cannot identify the symptoms of a stroke or heart attack, you may not obtain medical assistance quickly enough, which may result in permanent damage to the body or death. Even in survival, full abilities may not be regained, and months of costly medical care and rehabilitation may result. Besides symptom recognition, knowing to call 911 immediately for CVD events is critical.

Due to the large impact of CVD in Georgia, and the potential for improved outcomes through early detection and

treatment, the Georgia Division of Public Health conducted a statewide survey in 2006 to measure:

Knowledge of stroke signs

Ability to recognize a CVD event and call 911

Knowledge of heart attack signs

Knowledge of hypertension

Knowledge of modifiable CVD risk factors

Sources of information for CVD treatments

Results were analyzed to determine if knowledge differed by sex, race, age, income level, highest level of education attained, urban or rural residence, individual or family history of stroke or heart attack, and insurance status.
Key Findings

2.7 million Georgians, or 39% of Georgia adults, do not know the signs of stroke

1.3 million Georgians, or 19% of Georgia adults, do not know the signs of heart attack

Nearly 2.3 million, or 33% of Georgia adults, do not know the modifiable risk factors for CVD

3.2 million Georgians, or 46% of Georgia adults, cannot recognize a stroke and call 911

More than 2 million Georgians, or 30% of Georgia adults, cannot recognize a heart attack and call 911

Of all the factors affecting knowledge, education level had the greatest impact

Other factors significantly predicting knowledge,

in order of importance, were: race, income, age,

history of stroke, urban or rural residence, history of heart attack, and sex

Table of Contents

Actions Necessary to Improve Cardiovascular Awareness in Georgia

Knowledge of Stroke Signs.......................p.2 Knowledge of Heart Attack Signs................p.3 Ability to Recognize a Cardiovascular

In addition to other efforts to improve CVD outcomes in Georgia, interventions to improve awareness of stroke and heart attack signs and risk factors should be targeted to those with the greatest need, in order of importance:
1. Lower education level 2. Non-whites

Disease Event and Call 911.......................p.4 Knowledge of Modifiable Cardiovascular Disease Risk Factors...............................p.7 Knowledge of Hypertension.......................p.8 Where Respondents Heard About Cardiovascular Disease Treatments...........p.8

3. Low- to middle-income

Changes in Stroke Knowledge from

4. Younger than 45 / older than 65

1999 to 2006.........................................p.9

5. No personal or family CVD history

Methodology, References.......................p.10

6. Rural residents

7. Males

2006 GEORGIA STROKE & HEART ATTACK AWARENESS SURVEY

1

Knowledge of Stroke Signs
Total Population
39% of Georgia adults (2.7 million) do not know the signs of stroke
Percent of Adults who Identified 1 Stroke Sign, Georgia, 2006

39%

Know stroke

signs

61%

Do not know stroke signs

Knowledge of Stroke Signs by Age
Respondents between ages 45 and 64 were:
1.4 times more likely* than those ages 18-29 to identify at least one stroke sign
1.1 times more likely than those 65 and older to identify at least one stroke sign

Knowledge of Stroke Signs by Sex
No significant differences between Males and Females

Percent of Adults who Identified 1 Stroke Sign, by Sex, Georgia, 2006

100

80

64

58

60

40

20

0 M ale s

Fem ales

Percent of Adults who Identified 1 Stroke Sign, by Age, Georgia, 2006
100

80

62

69

61

60

50

40

20

0

18-29

30-44

45-64

65+

Age Group

Knowledge of Stroke Signs by Race

Knowledge of Stroke Signs by Income Level

Whites were 1.3 times more likely than Blacks to identify at least one stroke sign
Percent of Adults who Identified 1 Stroke Sign, by Race, Georgia, 2006
100

Those with incomes of $75,000 or higher were:
1.6 times more likely than those with incomes lower than $20,000 to identify at least one stroke sign
1.3 times more likely than those with incomes between $20,000 and $34,999 to identify at least one stroke sign

80

66

60

40

20

0 White s

52 Black s

* All differences presented in results are significant at = .05

Percent of Adults who Identified 1 Stroke Sign, by Income Level, Georgia, 2006

100

80

67

69

70

56

60

45

40

20

0 <$20,000 $20,000 - $35,000 - $50,000 - $75,000+ $34,999 $49,999 $74,999

2006 GEORGIA STROKE & HEART ATTACK AWARENESS SURVEY

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Knowledge of Stroke Signs by Education Level
College graduates were:
1.8 times more likely than those with no high school degree to identify at least one stroke sign
1.3 times more likely than those with only a high school degree to identify at least one stroke sign
Knowledge of Stroke Signs by Insurance Status
The insured (70%) were 1.3 times more likely than the non-insured (53%) to know a stroke sign

Percent of Adults who Identified 1 Stroke Sign, by Education Level, Georgia, 2006

100

80

72 64

55

60

40

40

20

0

No high High school Som e college College

s chool

graduate

graduate

degree

Knowledge of Stroke Signs by History of Stroke

Those with an individual or family history of stroke (68%) were 1.3 times more likely than those without a history (54%) to know a stroke sign

Knowledge of Heart Attack Signs
Total Population
19% of Georgia adults (1.3 million) do not know the signs of heart attack
Percent of Adults who Identified 1 Heart Attack Sign, Georgia, 2006
19%
Know heart attack signs
Do not know heart attack signs
81%

Knowledge of Heart Attack Signs by Sex

No significant differences between Males and Females
Percent of Adults who Identified 1 Heart Attack Sign, by Sex, Georgia, 2006

100

81

80

60

40

20

0 M ale s

81 Fem ales

Knowledge of Heart Attack Signs by Age

Knowledge of Heart Attack Signs by Race

Respondents between ages 45 and 64 were 1.2 times more likely than those ages 18-29 and those 65 and older to identify at least one heart attack sign

Whites were 1.3 times more likely than Blacks to identify at least one heart attack sign

Percent of Adults who Identified 1 Heart Attack Sign, by Age, Georgia, 2006

100 75

82

86

75

80

60

40

20

0

18-29

30-44

45-64

65+

Age Group

2006 GEORGIA STROKE & HEART ATTACK AWARENESS SURVEY

Percent of Adults who Identified 1 Heart Attack Sign, by Race, Georgia, 2006

100

86

80

60

40

20

0 White s

69 Black s

3

Knowledge of Heart Attack Signs by Income Level
Those with incomes of $75,000 or higher were;
1.5 times more likely than those with incomes lower than $20,000 to identify at least one heart attack sign
1.1 times more likely than those with incomes between $20,000 and $34,999 and between $35,000 and $49,999 to identify at least one heart attack sign

Percent of Adults who Identified 1 Heart Attack Sign, by Income Level, Georgia, 2006

100

89

91

81

81

80 60

60

40

20

0 <$20,000 $20,000 - $35,000 - $50,000 - $75,000+ $34,999 $49,999 $74,999

Knowledge of Heart Attack Signs by Education Level
College graduates were:
1.6 times more likely than those with no high school degree to identify at least one heart attack sign
1.2 times more likely than those with only a high school degree to identify at least one heart attack sign

Percent of Adults who Identified 1 Heart

Attack Sign, by Education Level, Georgia, 2006

100

85

90

76

80

55

60

40

20

0

No high High school Som e

s chool

graduate

colle ge

degree

Colle ge graduate

Knowledge of Heart Attack Signs by Residence
Urban residents were 1.1 times more likely than rural residents to know a heart attack sign

Percent of Adults who Identified 1 Heart Attack Sign, by Residence, Georgia, 2006

100

82

76

80

60

40

20

0

Urban

Rural

Knowledge of Heart Attack Signs by Insurance Status
The insured were 1.1 times more likely than the non-insured to know a stroke sign
Knowledge of Heart Attack Signs by History of Heart Attack
Those with an individual or family history of heart attack were 1.1 times more likely than those without a history to know a heart attack sign

Ability to Recognize a Cardiovascular Disease (CVD) Event and Call 911

Total Population: Stroke Response
46% of Georgia adults (nearly 3.2 million) cannot recognize a stroke and call 911
Percent of Adults who Could Recognize a Stroke and Call 911, Georgia, 2006

Total Population: Heart Attack Response
30% of Georgia adults (over 2 million) cannot recognize a heart attack and call 911
Percent of Adults who Could Recognize a Heart Attack and Call 911, Georgia, 2006

46%

Could recognize and respond
Could not 54% recognize and
respond

30%

70%

Could recognize and respond
Could not recognize and respond

2006 GEORGIA STROKE & HEART ATTACK AWARENESS SURVEY

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Ability to Recognize a CVD Event and Call 911: By Sex
No significant difference between Males and Females

Percent of Adults who Could Recognize a CVD Event and Call 911, by Sex, Georgia, 2006

100 80 57 60
40 20
0 M ale s

71 51
Fem ales Males

69 Fem ales

Stroke

Heart Attack

By Age
Respondents between ages 45 and 64 were 1.3 times more likely than those 65 and older to be able to identify a stroke and call 911

Percent of Adults who Could Recognize a CVD Event and Call 911, by Age, Georgia, 2006

100

80

57 61

74 75

62

61

60 43

49

40

20

0 18-29 30-44 45-64 65+ 18-29 30-44 45-64 65+

Age Group

Stroke

Heart Attack

Ability to Recognize a CVD Event and Call 911 by Race Percent of Adults who Could Recognize a CVD

Whites were 1.2 times more likely than Blacks to be able to identify a CVD event and call 911

Event and Call 911, by Race, Georgia, 2006

100

74

80

57

60

48

61

40

20

0

White

Black

White

Black

Stroke

Heart Attack

Ability to Recognize a Stroke and Call 911 by Income Level
Those with incomes of $75,000 or higher were:
1.7 times more likely than those with incomes lower than $20,000 to be able to recognize a stroke and call 911
1.2 times more likely than those with incomes between $20,000 and $34,999 to be able to recognize a stroke and call 911

Percent of Adults who Could Recognize a Stroke and Call 911, by Income Level, Georgia, 2006

100

80

61

63

60

60

36

50

40

20

0

<$20,000 $20,000 - $35,000 - $50,000 - $75,000+

$34,999 $49,999 $74,999

Ability to Recognize a Heart Attack and Call 911 by Income Level

Percent of Adults who Could Recognize a Heart Attack and Call 911, by Income Level, Georgia, 2006

Those with incomes of $75,000 or higher were 1.5 times more likely than those with incomes lower than $20,000 to be able to recognize a heart attack and call 911

100 80

69

72

79

79

60

52

40

20

0

2006 GEORGIA STROKE & HEART ATTACK AWARENESS SURVEY

<$20,000

$20,000 $34,999

$35,000 $49,999

$50,000 $74,999

$75,000+ 5

Ability to Recognize a Stroke and Call 911 by Education Level
College graduates were:
Twice as likely as those with no high school degree to be able to recognize a stroke and call 911
1.3 times more likely than those with only a high school degree to be able to recognize a stroke and call 911
Ability to Recognize a Heart Attack and Call 911 by Education Level
College graduates were:
1.7 times more likely than those with no high school degree to be able to recognize a heart attack and call 911
1.3 times more likely than those with only a high school degree to be able to recognize a heart attack and call 911

Percent of Adults who Could Recognize a Stroke and Call 911, by Education Level, Georgia, 2006

100

80

58

60

48

40

32

20

0

No high High school Som e

s chool

graduate

colle ge

degree

64
Colle ge graduate

Percent of Adults who Could Recognize a Heart Attack and Call 911, by Education Level, Georgia, 2006

100

74

80

80

63

60

47

40

20

0

No high s chool degree

High school graduate

Som e colle ge

Colle ge graduate

Ability to Recognize a Heart Attack and Call 911 by Residence
Urban residents were 1.1 times more likely than rural residents to be able to recognize a heart attack and call 911

Percent of Adults who Could Recognize a Heart Attack and Call 911, by Residence, Georgia, 2006

100

80

72

60

40

20

0 Urban

63 Rural

Ability to Recognize a CVD Event and Call 911 by Insurance Status
The insured (56%) were 1.3 times more likely than the uninsured (43%) to be able to recognize a stroke and call 911
The insured (72%) were 1.2 times more likely than the uninsured (59%) to be able to recognize a heart attack and call 911

Ability to Recognize a CVD Event and Call 911 by History of Stroke
Those with an individual or family history of stroke (59%) were 1.2 times more likely than those without a history (48%) to be able to recognize a stroke and call 911

2006 GEORGIA STROKE & HEART ATTACK AWARENESS SURVEY

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Knowledge of Modifiable Cardiovascular Disease (CVD) Risk Factors

Total Population
33% of Georgia adults (nearly 2.3 million) do not know the modifiable risk factors for CVD
This knowledge, if accompanied by effective action, is key to preventing and reducing CVD events
Percent of Adults who Identified 1 Modifiable CVD Risk Factor, Georgia, 2006

33%

Know risk

factors

Do not know risk factors
67%

Knowledge of Risk Factors by Sex
No significant differences between Males and Females

Percent of Adults who Identified 1 Modifiable CVD Risk Factor, by Sex, Georgia, 2006

100

80

68

66

60

40

20

0 M ale s

Fem ales

Knowledge of Risk Factors by Age
Respondents between ages 45 and 64 were 1.4 times more likely than those ages 18-29 and those 65 and older to identify at least one modifiable CVD risk factor

Knowledge of Risk Factors by Race

Whites were 1.5 times more likely than Blacks to identify at least one risk factor

Percent of Adults who Identified 1 Modifiable CVD Risk Factor, by Race, Georgia, 2006

100 75
80

60

49

40

20

0 White s

Black s

Percent of Adults who Identified 1 Modifiable

CVD Risk Factor, by Age, Georgia, 2006

100

80

70

76

56

56

60

40

20

0

18-29

30-44

45-64

65+

Age Group

Whites were significantly more likely than Blacks to identify these modifiable CVD risk factors:
High cholesterol Tobacco use Physical inactivity Obesity Diet

Knowledge of Risk Factors by Income Level
Those with incomes of $75,000 or higher were:
2.1 times more likely than those with incomes lower than $20,000 to identify at least one modifiable CVD risk factor
1.2 to 1.4 times more likely than those with incomes between $20,000 and $74,999 to identify at least one modifiable CVD risk factor

Percent of Adults who Identified 1 Modifiable CVD Risk Factor, by Income Level, Georgia, 2006

100

87

80

68

74

61

60 41

40

20

0 <$20,000 $20,000 - $35,000 - $50,000 - $75,000+ $34,999 $49,999 $74,999

2006 GEORGIA STROKE & HEART ATTACK AWARENESS SURVEY

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Knowledge of Risk Factors by Education Level
College graduates were:
2.5 times more likely than those with no high school degree to identify at least one modifiable CVD risk factor
1.6 times more likely than those with only a high school degree to identify at least one modifiable CVD risk factor
1.2 times more likely than those with only some college to identify at least one modifiable CVD risk factor

Percent of Adults who Identified 1 Modifiable CVD Risk Factor, by Education Level, Georgia, 2006

100

80

74

60

52

40

34

20

0

No high High school Som e

s chool

graduate

colle ge

degree

85
Colle ge graduate

Knowledge of Risk Factors by Residence
Urban residents were 1.3 times more likely than rural residents to know a modifiable CVD risk factor

Percent of Adults who Identified 1 Modifiable CVD Risk Factor, by Residence, Georgia, 2006

100

80

70

55 60

40

20

0 Urban

Rural

Knowledge of Risk Factors by Insurance Status
Insured respondents were 1.3 times more likely than non-insured respondents to know a modifiable CVD risk factor
Knowledge of Risk Factors by History of Stroke
Respondents with an individual or family history of stroke were 1.1 times more likely than those without a history to know a modifiable CVD risk factor
Knowledge of Risk Factors by History of Heart Attack
Respondents with an individual or family history of heart attack were 1.1 times more likely than those without a history to know a modifiable CVD risk factor

Knowledge of Hypertension

Where Respondents Heard About Cardiovascular Disease Treatments

Question

% answering correctly

High blood pressure (BP) can cause strokes

96

People taking medication for hypertension should take it

96

daily

High BP can cause heart attacks

95

Weight loss usually decreases BP

90

160/100 is high BP

87

Eating salt usually increases BP

78

Exercising usually decreases BP

77

High BP can NOT cause cancer

77

Hypertension usually lasts a lifetime

69

High BP can cause kidney disease

68

130/80 is normal BP

58

Most people with high BP feel fine/are asymptomatic

57

Drinking 1+ alcoholic drinks daily usually increases BP

56

Source

%

Newspaper, magazine, medical

33

journal

TV, radio

24

Hospital, doctor's office,

23

healthcare facility

Internet

16

Brochure, poster, flyer

14

* Respondents could select more than one option

2006 GEORGIA STROKE & HEART ATTACK AWARENESS SURVEY

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Changes in Stroke Knowledge from 1999 to 2006

Knowledge of Stroke Signs: Total Population and By Sex
In 2006, respondents (61%) were 1.6 times more likely to know 1 stroke sign than in 1999 (39%)
In 2006, males were 1.6 times more likely and females were 1.5 times more likely to know 1 stroke sign than in 1999
Percent of Adults who Identified 1 Stroke Sign, by Sex, Georgia, 1999 and 2006

1999 2006

100

80

64

58

60

39

38

40

20

0

M ale s

Fem ales

By Race
In 2006, both Whites and Blacks were 1.6 times more likely to know 1 stroke sign than in 1999

Percent of Adults who Identified 1 Stroke Sign, by Race, Georgia, 1999 and 2006

1999 2006 100

80

66

60

42

40

52 32

20

0

White s

Black s

By Education Level
Ability to identify 1 stroke sign increased from 1999 to 2006 for respondents with the following education:
High school graduate Some college College graduate

Percent of Adults who Identified 1 Stroke Sign, by Education Level, Georgia, 1999 and 2006

100

80

60

40

40 31

1999 55 31

2006 64
39

20

0 No high High school Som e school graduate college degree

72 53
Colle ge graduate

By Age
In 2006, respondents in all age groups except those 65 and older were more likely to know 1 stroke sign than in 1999

Percent of Adults who Identified 1 Stroke Sign, by Age, Georgia, 1999 and 2006

100

80

60

50

40 27

20

0 18-29

1999 62 38

2006 69
47

30-44

45-64

61 47
65+

Age Group

By Income Level
Ability to identify 1 stroke sign increased from 1999 to 2006 for respondents with incomes of:
$20,000-$34,999 $35,000-$49,999 $75,000+

Percent of Adults who Identified 1 Stroke Sign, by Income Level, Georgia, 1999 and 2006

100
80 60 43 45
40

1999 2006

56 31

67 33

69 56

70 43

20 0

<$20,000 $20,000- $35,000- $50,000- $75,000+

$34,999 $49,999 $74,999

By Residence
Urban residents were 1.7 times more likely to know 1 stroke sign in 2006 than in 1999
Percent of Adults who Identified 1 Stroke Sign, by Residence, Georgia, 1999 and 2006

100

1999 2006

80

62

60

37

40

59 43

20

0

Urban

Rural

Would Call 911 for Stroke
In 2006, respondents (86%) were 1.2 times more likely to say they would call 911 for stroke compared to 1999 (70%) * Rates not corrected for knowledge of stroke signs (see Methodology for details)

2006 GEORGIA STROKE & HEART ATTACK AWARENESS SURVEY

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Methodology

In 2006, the Georgia Division of Public Health conducted a statewide, random-digit dialed telephone survey (N=3,000) on stroke and heart attack awareness. This was a follow-up to a study conducted in 1999, which was limited to the metro Atlanta area and measured awareness of stroke signs only. For the 2006 study, an adult was selected at random from each household for interview. The sample was comprised of three groups of Georgia counties stratified by cardiovascular disease (CVD) death rate. Each stratum contained 1,000 respondents. With this design, analysis could account for geographic differences in CVD death rates. Weighted data were analyzed using SAS and SAS-callable SUDAAN.

Knowledge was measured using open-ended questions, which provide a more accurate assessment than multiple choice questions.2,3 A sample question measuring knowledge of stroke symptoms is: "What are the signs or symptoms of a person having a stroke? Try to tell me as many as you can." The interviewer would then let the respondent state as many symptoms as they could, without prompting the respondent or giving any suggestions. Respondents were coded positive for knowledge if they stated at least one item in the respective category:

Stroke signs
Weakness or numbness in face, arm, or leg Sudden confusion or difficulty speaking Dizziness or loss of coordination or balance Headache Vision problems

Heart attack signs
Chest pain Shortness of breath Arm or shoulder pain or discomfort Feeling weak, faint, or lightheaded Jaw, neck, or back pain or discomfort

Modifiable cardiovascular disease risk factors High blood pressure High cholesterol Overweight/obesity Sedentary lifestyle Smoking Diabetes Poor diet

A combination of questions was used to measure the ability to recognize a CVD event and call 911. Example for "Ability to recognize a stroke and call 911":

What are the signs or symptoms of a person having a stroke? (open-ended)

If you or someone you know experiences any

+

signs or symptoms of a stroke, what should

you do? (open-ended)

Only respondents who correctly answered both questions were considered able to recognize and respond to a stroke. If they could not answer the first question right, even if they knew that you should call 911 for a stroke, in a real-life situation the respondent might not recognize the stroke and therefore might not take the proper action. Improper analysis of such items can result in highly inflated knowledge estimates. In this survey, 86% of respondents said they would call 911 in the event of a stroke. However, after screening out those who could not identify at least one stroke sign, the true prevalence was found to be 54%.

Response Rates

CASRO rate Cooperation rate Overall response rate

45.3% 75.6% 18.5%

For response rate definitions, please see the 2005 Behavioral Risk Factor Surveillance System Data Quality Report Handbook at: http://www.cdc.gov/brfss/technical_infodata/surveydata/2005/2005DQRHandbook.rtf

References
1 Derived from national estimates published by the American Heart Association. Heart Disease and Stroke Statistics- 2004 Update. Dallas, TX: American Heart Association; 2004. 2 Schneider AT, Pancioli AM, Khoury JC, et al. Trends in Community Knowledge of the Warning Signs and Risk Factors for Stroke. JAMA. 2003;289:343-346. Available from: http://jama.ama-assn.org/cgi/content/full/289/3/343 3 Croft JB, Greenlund KJ, Ayala C, et al. Awareness of Stroke Warning Signs --- 17 States and the U.S. Virgin Islands, 2001. MMWR. 2004 May 7;53(17):359-62. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5317a2.htm

Suggested citation: Clarkson, LS. 2006 Georgia Stroke and Heart Attack Awareness Survey. Georgia Department of Human Resources, Division of Public Health, October 2008. Publication Number: DPH08/335.
For more on cardiovascular disease in Georgia, please visit http://health.state.ga.us or email ga-cvh@dhr.state.ga.us

2006 GEORGIA STROKE & HEART ATTACK AWARENESS SURVEY

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