title: Stroke Symptoms as a Predictor of Future Hospitalization.
abstract: BACKGROUND
  Stroke symptoms in the general adult population are common and associated with stroke risk factors, lower physical and mental functioning, impaired cognitive status, and future stroke. Our objective was to determine the association of stroke symptoms with self-reported hospitalization or emergency department (ED) visit.
  
  
  METHODS
  Lifetime history of stroke symptoms (sudden weakness, numbness, unilateral or general loss of vision, loss of ability to communicate or understand) was assessed at baseline in a national, population-based, longitudinal cohort study of 30,239 blacks and whites younger than 45 years, enrolled from 2003 to 2007. Self-reported hospitalization or ED visit and reason were collected during follow-up through March 2013. The symptom-hospitalization association was assessed by proportional hazards analysis in persons who were stroke/transient ischemic attack-free at baseline (27,126) with adjustment for sociodemographics and further adjustment for risk factors.
  
  
  RESULTS
  One or more stroke symptoms were reported by 4758 (17.5%). After adjustment for sociodemographics, stroke symptoms were most strongly associated with greater risk of hospitalization/ED for cardiovascular disease (CVD) (hazard ratio [HR] = 1.87, 95% confidence interval [CI]: 1.78-1.96), stroke (HR = 1.69, 95% CI: 1.55-1.85), and any reason (HR = 1.39, 95% CI: 1.34-1.44). These associations remained significant and only modestly reduced after risk factor adjustment.
  
  
  CONCLUSIONS
  Stroke symptoms are a marker for future hospitalization and ED visit not only for stroke but also for CVD in general. Findings suggest a role for stroke symptom assessment as a novel and simple approach for identifying individuals at high risk for CVD including stroke in whom preventive strategies could be implemented.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: vjhoward@uab.edu.
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.affiliation: Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.affiliation: Dean's Office, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Shauntice
authors.initials: S
authors.lastname: Allen
authors.affiliation: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Judd
authors.affiliation: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: J David
authors.initials: JD
authors.lastname: Rhodes
authors.affiliation: Department of Neurology, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Dawn O
authors.initials: DO
authors.lastname: Kleindorfer
authors.affiliation: Departments of Epidemiology/Prevention and Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.affiliation: Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida.
authors.forename: James F
authors.initials: JF
authors.lastname: Meschia
authors.affiliation: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: George
authors.initials: G
authors.lastname: Howard
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000503:physiopathology*; D055815:Young Adult
keywords: Stroke symptoms; cardiovascular disease; hospitalization; prospective studies; stroke