One-Third of US Adults Lack Recommended Stroke Knowledge

Stroke. Colored three-dimensional MRA (magnetic resonance angiography) scan of internal bleeding (red, center right) in a stroke victim’s brain. Arteries are pink. The brain damage of a stroke (or CVA, cerebrovascular accident) results from pressure from the internal bleeding. The brain is seen from the front. The bleeding is in the left hemisphere of the brain, and has caused hemiplegia (paralysis) in the right half of the body, as well as aphasia (a speech disorder). MRA is a magnetic resonance imaging (MRI) technique that highlights blood vessels. For an MRA scan of a healthy brain, see image SB4129.
Only about two-thirds of adults in the United States could identify the combination of recommended stroke knowledge, suggesting more education and outreach is needed.

Roughly two-thirds of US adults know the 5 signs and symptoms of stroke and the importance of calling emergency medical services following stroke onset; this suggests more public outreach and education is needed to further reduce delays in initiation of appropriate stroke care, according to data published in the Centers for Disease Control and Prevention (CDC) MMWR Morbidity and Mortality Weekly Report.

In the report, officials from the CDC highlight data from a 2017 National Health Interview Survey (NHIS) of 26,076 adults aged at least 20 years old. Using these survey data, investigators assessed the overall prevalence of “recommended stroke knowledge,” otherwise known as the knowledge of the 5 signs and symptoms of stroke and the immediate need to call 9-1-1. The 5 signs and symptoms include numbness in the face and extremities, confusion and difficulty speaking, sudden trouble seeing, trouble walking, and sudden severe headache.

Most respondents to the NHIS could recognize at least 1 symptom and sign of stroke, and the majority of participants knew to call emergency medical services immediately following the onset of these signs/symptoms (96.3%). Knowledge was highest for facial and extremity numbness (94.4%), followed by confusion and difficulty speaking (93.6%), trouble walking (90.8%), sudden trouble seeing (83.5%), and sudden severe headache (76.5%). Collectively, 69.1 percent of respondents knew all 5 stroke signs and symptoms, and 67.5 percent of respondents knew all 5 signs and symptoms and knew to call 9-1-1. 

Study researchers observed differences in recommended stroke knowledge between subgroups, ranging from 57.8% among Hispanic adults to 71.3% among non-Hispanic White adults. Additionally, the prevalence of recommended stroke knowledge ranged from 54.8% in adults with less than a high school education to 73.1% for those who were college graduates. Significant disparities in recommended stroke knowledge continued to persist after multivariable adjustment.

Limitations of the CDC report were the reliance on self-reported data, potential recall and social desirability bias, inability of questions to address all stroke signs and symptoms, the use of yes/no questions, and the lack of an established standard for stroke awareness.

The report suggests that “focused public health efforts, community engagement, innovative strategies to tailor messaging, and continued advances in clinical care and coordination might help address stalled declines in stroke mortality” and that “increasing awareness of the signs and symptoms of stroke continues to be a national priority.” 


Jackson SL, Legvold B, Vahratian A, et al. Sociodemographic and geographic variation in awareness of stroke signs and symptoms among adults – United States, 2017. MMWR Morb Mortal Wkly Rep. 2020;69(44):1617-1621. doi:10.15585/mmwr.mm6944a1