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We theorize that the southeastern United States has a higher stroke mortality rate and higher recurrent ischemic stroke rate than the rest of the United States due to (1) an increased prevalence of hypercoagulable states among young adults in the region, (2) failure to diagnose hypercoagulable states as the cause of ischemic stroke in young adults, and (3) underutilization of anticoagulation for ischemic stroke secondary prevention in young adults with hypercoagulable states. In an attempt to investigate this hypothesis, we conducted a retrospective chart review of 311 inpatients with first-ever ischemic stroke from age 18 to 55 years at an Oklahoma academic medical center from 1 July 2011 to 30 April 2017. Using Chi-squared test, we compared the stroke etiologic diagnosis of the attending neurologist at discharge—when hypercoagulable profile results were rarely available—to the diagnosis of a vascular neurologist postdischarge who had access to all available etiologic test results. The inpatient neurologists identified the stroke etiology as hypercoagulable state in 79 patients (25.57%) and undetermined etiology in 105 (33.98%). With the benefit of final hypercoagulable profile results, the postdischarge vascular neurologist identified the stroke etiology as hypercoagulable state in 167 (54.22%, 95% CI 48.64–59.70%, p -value <2.2e-16) and undetermined etiology in 28 (9.09%, 95% CI 6.36–12.83%, p -value 1.03e-14). There was no significant change in the proportion of ischemic strokes classified under all other stroke etiologies. We conclude that hypercoagulable states are a common and underrecognized cause of ischemic stroke in young adults in the U.S. Stroke Belt. [ABSTRACT FROM AUTHOR]

We theorize that the southeastern United States has a higher stroke mortality rate and higher recurrent ischemic stroke rate than the rest of the United States due to (1) an increased prevalence of hypercoagulable states among young adults in the region, (2) failure to diagnose hypercoagulable states as the cause of ischemic stroke in young adults, and (3) underutilization of anticoagulation for ischemic stroke secondary prevention in young adults with hypercoagulable states. In an attempt to investigate this hypothesis, we conducted a retrospective chart review of 311 inpatients with first-ever ischemic stroke from age 18 to 55 years at an Oklahoma academic medical center from 1 July 2011 to 30 April 2017. Using Chi-squared test, we compared the stroke etiologic diagnosis of the attending neurologist at discharge—when hypercoagulable profile results were rarely available—to the diagnosis of a vascular neurologist postdischarge who had access to all available etiologic test results. The inpatient neurologists identified the stroke etiology as hypercoagulable state in 79 patients (25.57%) and undetermined etiology in 105 (33.98%). With the benefit of final hypercoagulable profile results, the postdischarge vascular neurologist identified the stroke etiology as hypercoagulable state in 167 (54.22%, 95% CI 48.64–59.70%, p-value

BackgroundStroke is associated with racial disparities in morbidity and mortality and stroke outcomes. Stroke literacy is a significant predictor of on-time arrival to the emergency room for acute stroke treatment. In this study, we examined sociodemographic and socioeconomic factors that predict key aspects of stroke literacy: knowledge of stroke signs/symptoms and intent to call 911 in the event of a stroke.MethodsWe analyzed archived data from a survey of African American adults over 18 years residing in the “buckle of the stroke belt.” Participants were ranked into 2 categories: low or no and moderate to adequate stroke knowledge. Then we performed univariate and multivariable analyses to determine the independent predictors of (1) knowledge of stroke signs and symptoms and (1) intent to call 911.ResultsParticipants aged 18–39 years (OR = 0.46, 95% CI: 0.27– 0.80) were more likely to correctly recognize stroke signs and symptoms compared to those who are 65 years and above. Those age 40–64 years were also more likely to recognize stroke signs and symptoms compared to those who are 65 years and above. On the other hand, those with less than high school (OR = 2.83, 95% CI: 2.03–3.96) or complete high school education (OR = 1.95, 95% CI: 1.28–2.96) were less likely to recognize stroke signs and symptoms. Males were less likely (OR = 0.65, 95% CI: 0.64–0.66) to report that they would call 911 in the event of a stroke. While respondents aged 40–64 years (OR = 1.87, 95% CI: 1.14–3.09) and those with moderate to adequate knowledge of stroke (OR = 1.39, 95% CI: 1.18–1.65) were more likely to call 911 in the event of a stroke. Socioeconomic status was generally associated with stroke literacy.ConclusionAmong resident of the “buckle of the stroke belt,” we observed that age, sex, and educational level are among the key predictors of knowledge of stroke signs and symptoms and intent to call 911 in the event of a stroke. Stroke literacy and educational programs needs to incorporate these key sociodemographic aspects as a strategy for improving literacy and reduce stroke-related disability and health disparities.