Journal List > Korean J Adult Nurs > v.31(4) > 1130755

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

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.

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Table 1.
Sociodemographic and Health-related Characteristics of Patients (N=15,536)
Variables Categories Total
n %
Gender   Men 7,213 51.9
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
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
Without spouse 5,129 31.1
Subjective health status Good/fair 7,092 49.8
Poor 8,443 50.2
Drinking (frequency) ≤4/month 12,735 79.7
≥2/week 2,798 20.3
Current smoking Yes 2,144 16.9
No 13,392 83.1
Perceived stress Low 11,960 74.6
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
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)
n % n %
Total 7,380 48.8 8,156 51.2
Gender   Men 3,624 51.6 3,589 48.4 52.90 (<.001)
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)
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)
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)
Poor 3,822 46.0 4,621 54.0
Drinking (frequency) ≤4/month 6,024 48.6 6,711 51.4 0.75 (.536)
≥2/week 1,356 49.5 1,442 50.5
Current smoking Yes 1,001 46.5 1,143 53.5 6.72 (.075)
No 6,379 49.2 7,013 50.8
Perceived stress Low 5,691 48.7 6,269 51.3 0.11 (.811)
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)
≥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)
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)
OR (95% CI) p OR (95% CI) p
Gender   Men 1 1
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
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
Without spouse 1.32 (1.12~1.45) .001 1.28 (1.17~1.40) .001
Subjective health status Good/ fair 1
Poor 1.05 (0.96~1.14) .272
Drinking (frequency) ≤4/month 1
≥2/week 1.14 (1.02~1.27) .017
Current smoking No 1
Yes 1.27 (1.13~1.42) .001
Perceived stress High 1
Low 1.01 (0.92~1.16) .798
Body mass index (kg/m2) ≥25 1
25 1.07 (0.98~1.15) .121
Education for the management of hypertension and diabetes Yes 1
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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