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

Mirae Jo; Heeyoung Oh; Suk-Yong Jang; Ahra Jo

doi:10.7475/kjan.2019.31.4.403

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Jo, Oh, Jang, and Jo: 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

Original Article

Korean J Adult Nurs 2019;31(4):403-413.

Published online: 21 August 2019

DOI: https://doi.org/10.7475/kjan.2019.31.4.403

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

Mirae Jo¹, Heeyoung Oh^2,, Suk-Yong Jang³, Ahra Jo⁴

¹Doctoral Student, Graduate School, College of Nursing, Eulji University, Daejeon, Korea

²Professor, College of Nursing, Eulji University, Daejeon, Korea

³Assistant Professor, Department of Preventive Medicine, School of Medicine, Eulji University, Daejeon, Korea

⁴Assistant Professor, Department of Nursing, Songho University, Hoengseong, Korea

Corresponding author: Oh, Heeyoung https://orcid.org/0000-0002-8053-3565 College of Nursing, Eulji University, 77 Gyeryong-ro, 771 beon-gil, Jung-gu, Daejeon 34824, Korea. Tel: +82-42-259-1713, Fax: +82-42-259-1709, E-mail: hoh123@eulji.ac.kr

Received 30 April 201910 June 2019 Accepted 25 June 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

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, x² 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.

Keywords: Stroke, Awareness, Hypertension, Diabetes mellitus

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Table 1.

Sociodemographic and Health-related Characteristics of Patients (N=15,536)

Variables	Categories	Total
Variables	Categories	n^†	%^‡
Gender	Men	7,213	51.9
Gender	Women	8,323	48.1
Age (year)	30~49	755	8.1
	50~69	7,040	49.8
	≥70	7,741	42.1
Education	≤ Elementary school	7,615	36.6
	Middle school	2,703	18.0
	High school	3,400	27.6
	≥ College	1,797	17.8
Monthly household income (10,000 won)	200	9,559	50.3
	200~399	3,550	26.4
	≥400	2,283	23.3
Residential area	Urban	6,985	74.6
Residential area	Rural	8,551	25.4
Occupation	Profession/managers/clerks	890	9.5
	Sales/service workers	1,092	7.8
	Agricultural/forestry/fishery workers/labor	4,876	24.2
	Others	8,656	58.5
Marital status	With spouse	10,390	68.9
Marital status	Without spouse	5,129	31.1
Subjective health status	Good/fair	7,092	49.8
Subjective health status	Poor	8,443	50.2
Drinking (frequency)	≤4/month	12,735	79.7
Drinking (frequency)	≥2/week	2,798	20.3
Current smoking	Yes	2,144	16.9
Current smoking	No	13,392	83.1
Perceived stress	Low	11,960	74.6
Perceived stress	High	3,564	25.4
Body mass index (kg/m²)	<25	8,494	56.7
	≥25	5,933	43.3
Education for the management of hypertension and diabetes	Yes	4,475	31.2
Education for the management of hypertension and diabetes	No	11,061	68.8

^† Unweighted number, subtotal varies due to missing data;

^‡ Weighted percent.

Table 2.

Awareness of Warning Signs of Stroke among Hypertensive Diabetic Patients (N=15,536

Variables	Categories	n^†	%^‡
Warning signs identified	Sudden severe headache with unknown cause	9,877	65.2
	Sudden trouble seeing in one or both eyes	9,980	65.7
	Sudden numbness or weakness of face, arm, or leg	11,732	76.2
	Sudden trouble walking, dizziness, or loss of balance	11,749	76.8
	Sudden trouble speaking or understanding	12,063	79.0
Number of warning signs identified	None	1,980	11.8
	1	627	4.3
	2	1,183	6.7
	3	1,956	12.3
	4	2,410	16.1
	5	7,380	48.8

^† Unweighted number;

^‡ Weighted percent.

Table 3.

Differences in Unawareness of Warning Signs of Stroke according to Socio-Demographic and Health-related Characteristics (N=15,536)

Variables	Categories	Aware		Unaware		x² (p)
Variables	Categories	n^†	%^‡	n^†	%^‡	x² (p)
Total		7,380	48.8	8,156	51.2
Gender	Men	3,624	51.6	3,589	48.4	52.90 (＜.001)
Gender	Women	3,756	45.7	4,567	54.3
Age (year)	30~49	382	49.8	373	50.2	229.27 (＜.001)
	50~69	3,795	54.5	3,245	45.5
	≥70	3,203	41.8	4,538	58.2
Education	≤ Elementary school	3,097	39.5	4,518	60.5	374.29 (＜.001)
	Middle school	1,400	48.9	1,303	51.1
	High school	1,830	53.9	1,570	46.1
	≥ College	1,042	59.7	755	40.3
Monthly household income (10,000 won)	200	4,252	44.7	5,307	55.3	102.67 (＜.001)
	200~399	1,845	52.3	1,705	47.7
	≥400	1,213	53.4	1,070	46.6
Residential area	Urban	3,383	49.3	3,602	50.7	4.73 (.060)
Residential area	Rural	3,997	47.3	4,554	52.7
Occupation	Profession/ managers/ clerks	512	59.5	378	40.5	128.29 (＜.001)
	Sales/ service workers	633	57.5	459	42.5
	Agricultural/ forestry/	2,373	47.6	2,503	52.4
	fishery workers/ labor
	Others	3,853	46.3	4,803	53.7
Marital status	With spouse	5,315	52.2	5,075	47.8	166.08 (＜.001)
Marital status	Without spouse	2,056	41.1	3,073	58.9
Subjective health status	Good/fair	3,558	51.6	3,534	48.4	47.65 (＜.001)
Subjective health status	Poor	3,822	46.0	4,621	54.0
Drinking (frequency)	≤4/month	6,024	48.6	6,711	51.4	0.75 (.536)
Drinking (frequency)	≥2/week	1,356	49.5	1,442	50.5
Current smoking	Yes	1,001	46.5	1,143	53.5	6.72 (.075)
Current smoking	No	6,379	49.2	7,013	50.8
Perceived stress	Low	5,691	48.7	6,269	51.3	0.11 (.811)
Perceived stress	High	1,688	49.0	1,876	51.0
Body mass index (kg/m²)	25	4,065	48.1	4,429	51.9	17.28 (.003)
Body mass index (kg/m²)	≥25	2,973	51.6	2,960	48.4
Education for the management of hypertension and diabetes	Yes	2,300	50.7	2,175	49.3	10.73 (.019)
Education for the management of hypertension and diabetes	No	5,080	47.9	5,981	52.1

^† Unweighted number;

^‡ Weighted percent.

Table 4.

Factors Influencing Unawareness of Warning Signs of Stroke among Hypertensive Diabetic Patients (N=15,536)

Variables	Categories	Model I (n=15,348)^†		Model II (n=14,258)^‡
Variables	Categories	OR (95% CI)	p	OR (95% CI)	p
Gender	Men	1		1
Gender	Women	0.92 (0.84~1.00)	.061	1.02 (0.92~1.12)	.750
Age (year)	50~69	1		1
	30~49	1.49 (1.25~1.77)	.001	1.43 (1.20~1.70)	.001
	≥70	1.36 (1.24~1.48)	.001	1.38 (1.26~1.51)	.001
Education	≥ College	1		1
	≤ Elementary school	2.02 (1.75~2.32)	.001	1.91 (1.65~2.20)	.001
	Middle school	1.54 (1.33~1.78)	.001	1.51 (1.31~1.75)	.001
	High school	1.27 (1.11~1.45)	.001	1.24 (1.09~1.42)	.001
Monthly household income (10,000 won)	200	1		1
	200~399	0.98 (0.87~1.11)	.766	0.98 (0.87~1.11)	.727
	≥400	0.92 (0.82~1.04)	.205	0.92 (0.81~1.04)	.259
Residential area	Rural	1		1
Residential area	Urban	1.06 (0.98~1.15)	.139	1.08 (0.99~1.17)	.068
Occupation	Profession/ managers/ clerks	1		1
	Sales/ service workers	0.94 (0.76~1.16)	.535	0.94 (0.76~1.16)	.561
	Agricultural/ forestry/ fishery workers/ labor	1.24 (1.03~1.48)	.020	1.24 (1.04~1.49)	.018
	Others	1.09 (0.92~1.30)	.318	1.09 (0.91~1.30)	.334
Marital status	With spouse	1		1
Marital status	Without spouse	1.32 (1.12~1.45)	.001	1.28 (1.17~1.40)	.001
Subjective health status	Good/ fair			1
Subjective health status	Poor			1.05 (0.96~1.14)	.272
Drinking (frequency)	≤4/month			1
Drinking (frequency)	≥2/week			1.14 (1.02~1.27)	.017
Current smoking	No			1
Current smoking	Yes			1.27 (1.13~1.42)	.001
Perceived stress	High			1
Perceived stress	Low			1.01 (0.92~1.16)	.798
Body mass index (kg/m²)	≥25			1
Body mass index (kg/m²)	25			1.07 (0.98~1.15)	.121
Education for the management of hypertension and diabetes	Yes			1
Education for the management of hypertension and diabetes	No			1.04 (0.95~1.13)	.388

CI=confidence interval; OR=odds ratio;

^† Missing values of n=188 are excluded for analysis, Nagelkerke R²=0.05, Wald F=30.47, p＜.001;

^‡ Missing values of n=1,278 are excluded for analysis, Nagelkerke R

² =0.05, Wald F=19.27, p＜.001.

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