Factors Related to Stroke Awareness and Severity in an Underserved Urban Community

Background Despite experiencing an increased incidence in stroke, minority groups have the lowest reported knowledge of stroke signs and symptoms and are less likely to receive time-sensitive interventions. There is a need to explore the relationship between social determinants of health and stroke awareness and severity within at-risk communities. Objectives The aim of this study was to explore relationships between social determinants of health and stroke awareness and severity in an underserved area located in a city borough in Northeastern United States. Methods We used an exploratory descriptive retrospective design and existing data. Data from 1,162 patients discharged with a principal diagnosis of stroke (ischemic stroke, subarachnoid hemorrhage, or intracerebral hemorrhage) were analyzed to explore the relationship between social determinants of health (age, sex, race, ethnicity, payer status, zip code) and stroke awareness and severity. Results Age group, race, and hospital arrival method were all significant indicators of time to arrival at the hospital. When holding all other factors in the model constant, being 65 years of age or older was associated with a decrease in time to reach the hospital compared to those under 65 years of age. Those who traveled by private transport had longer discovery to arrival times when holding all other factors constant, as compared to those who arrived by emergency medical services. Compared to persons who were White, persons who were Black or Asian saw increased times to hospital arrival. Discussion This study found that social determinants of health including age, race, sex, and insurance type significantly influenced stroke awareness and/or severity. These study findings can be used by stroke program leadership and community nurses to direct community-centered stroke awareness outreach.