Temporal Trends in Public Stroke Awareness in Korea, 2009 to 2023

Abstract

Background: No large-scale survey on public stroke awareness has been conducted in Korea since 2009. This study assessed temporal trends in awareness of stroke warning signs (WSs) and risk factors (RFs) from 2009 to 2023. We hypothesized that stroke awareness remains inadequate and that changes in information sources have influenced the depth of knowledge. Methods: Surveys were conducted nationwide in 2009 (n=1000) and 2023 (n=1012) assessing participants' knowledge of WSs, RFs, stroke treatment, response to stroke symptoms, and information sources. Multivariable logistic regression was used to analyze trends in RF knowledge and factors associated with adequate stroke response, which is contacting emergency medical services immediately. Results: Between 2009 and 2023, the percentage of participants unable to identify any WS or RF significantly decreased (WSs: 38.5% to 22.6%, RFs: 43.9% to 37.2%; P<0.01). However, recognition of multiple RFs declined significantly (51.4% to 40.2%, P<0.01), with a more pronounced decrease among those without vascular RFs (adjusted odds ratio, 0.33 [95% CI, 0.21-0.51]; P=0.03 for the interaction term). In contrast, the decline was less pronounced among individuals with vascular RFs (adjusted odds ratio, 0.56 [95% CI, 0.42-0.74]). Intravenous thrombolysis awareness increased (30.4% to 55.6%, P<0.01), and adequate stroke response improved (32.5% to 48.9%, P < 0.01). Information sources shifted, with an increase in the use of digital platforms. Adequate stroke response was significantly associated with intravenous thrombolysis knowledge (adjusted odds ratio, 1.54 [95% CI, 1.09-2.18]; P=0.02) and recognition: of >= 2 WSs (adjusted odds ratio, 1.43 [95% CI, 1.09-1.86]; P=0.01). Conclusions: Although stroke awareness has seen some improvements, it remains insufficient, highlighting the need for targeted educational strategies.