title: Knowledge of heart attack and stroke symptomology: a cross-sectional comparison of rural and non-rural US adults.
abstract: BACKGROUND
  Understanding the signs and symptoms of heart attacks and strokes are important not only in saving lives, but also in preserving quality of life. Findings from recent research have yielded that the prevalence of cardiovascular disease risk factors are higher in rural populations, suggesting that adults living in rural locales may be at higher risk for heart attack and/or stroke. Knowledge of heart attack and stroke symptomology as well as calling 911 for a suspected heart attack or stroke are essential first steps in seeking care. This study sought to examine the knowledge of heart attack and stroke symptoms among rural adults in comparison to non-rural adults living in the U.S.
  
  
  METHODS
  Using multivariate techniques, a cross-sectional analysis of an amalgamated multi-year Behavioral Risk Factor Surveillance Survey (BRFSS) database was performed. The dependent variable for this analysis was low heart attack and stroke knowledge score. The covariates for the analysis were: age, sex, race/ethnicity, annual household income, attained education, health insurance status, having a health care provider (HCP), timing of last routine medical check-up, medical care deferment because of cost, self-defined health status and geographic locale.
  
  
  RESULTS
  The weighted n for this study overall was 103,262,115 U.S. adults  > =18 years of age. Approximately 22.0% of these respondents were U.S. adults living in rural locales. Logistic regression analysis revealed that those U.S. adults who had low composite heart attack and stroke knowledge scores were more likely to be rural (OR=1.218 95%CI 1.216-1.219) rather than non-rural residents. Furthermore, those with low scores were more likely to be: male (OR=1.353 95%CI 1.352-1.354), >65 years of age (OR=1.369 95%CI 1.368-1.371), African American (OR=1.892 95%CI 1.889-1.894), not educated beyond high school (OR=1.400 955CI 1.399-1.402), uninsured (OR=1.308 95%CI 1.3-6-1.310), without a HCP (OR=1.216 95%CI 1.215-1.218), and living in a household with an annual income of  < $50,000 (OR=1.429 95%CI 1.428-1.431).
  
  
  CONCLUSIONS
  Analysis identified clear disparities between the knowledge levels U.S. adults have regarding heart attack and stroke symptoms. These disparities should guide educational endeavors focusing on improving knowledge of heart attack and stroke symptoms.
authors.affiliation: College of Pharmacy, Ambulatory Care Residency Program, University of Minnesota, Minneapolis, MN 55455, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Swanoski
authors.forename: May Nawal
authors.initials: MN
authors.lastname: Lutfiyya
authors.forename: Maria L
authors.initials: ML
authors.lastname: Amaro
authors.forename: Michael F
authors.initials: MF
authors.lastname: Akers
authors.forename: Krista L
authors.initials: KL
authors.lastname: Huot
mesh_terms: D000328:Adult; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D016001:Confidence Intervals; D003955:Diagnostic Tests, Routine / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006304:Health Status; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology / Q000523:psychology*; D010808:Physical Examination / Q000523:psychology; D011159:Population Surveillance; D011314:Preventive Health Services / Q000706:statistics & numerical data; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012923:Social Class; D020521:Stroke / Q000208:ethnology / Q000523:psychology*; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data