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Care seeking after stroke symptoms
Author(s) -
Howard Virginia J.,
Lackland Daniel T.,
Lichtman Judith H.,
McClure Leslie A.,
Howard George,
Wagner Libby,
Pulley Leavonne,
Gomez Camilo R.
Publication year - 2008
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.21357
Subject(s) - medicine , stroke (engine) , odds ratio , confidence interval , population , diabetes mellitus , cohort , mechanical engineering , environmental health , engineering , endocrinology
Objective To assess risk factors associated with care for stroke symptoms. Methods Using data from the population‐based national cohort study ( RE asons for G eographic A nd R acial D ifferences in S troke) conducted January 25, 2003–February 28, 2007 (N = 23,664), we assessed care‐seeking behavior among 3,668 participants who reported a physician diagnosis of stroke/transient ischemic attack (n = 647) or stroke symptoms (n = 3,021) during follow‐up. Care seeking was defined as seeking medical attention after stroke symptoms or a physician diagnosis. Results Overall, 58.5% of participants (2,146/3,668) sought medical care. In multivariable models, higher income was associated with greater likelihood of seeking care ( p = 0.02): participants with income of ≥$75,000 had odds 1.43 times (95% confidence interval [CI], 1.02–2.02) greater than those with income of less than $20,000. Diabetes and previous heart disease were associated with increased care seeking: odds ratio (OR) of 1.23 (95% CI, 1.04–1.47) and OR of 1.26 (95% CI, 1.06–1.49), respectively. Participants with previous stroke symptoms but no stroke history were less likely to seek care than those with stroke history or without previous symptoms (OR, 0.80; 95% CI, 0.67–0.96). Past smoking was associated with lower likelihood (OR, 0.71; 95% CI, 0.59–0.85; p = 0.0003) of seeking care relative to nonsmokers. Interpretation Only approximately half of participants with stroke symptoms sought care. This is despite the encouragement of advocacy groups to seek prompt attention for stroke symptoms. Our results highlight the importance of identifying characteristics associated with care‐seeking behavior. Recognizing factors that contribute to delays provides opportunities to enhance education on the importance of seeking care for stroke symptoms. Ann Neurol 2008