Geographic Disparities in Stroke Action Awareness in China: A National Survey

Stroke incidence and mortality are higher among adults in northern and western China, commonly referred to as the "Stroke Belt." However, few studies have compared stroke action awareness between Stroke Belt and non-Stroke Belt regions at the national level. This study aimed to evaluate stroke action awareness-including recognition of symptoms and appropriate emergency responses-among community residents in China, with comparisons between Stroke Belt and non-Stroke Belt regions.

We conducted a cross-sectional, questionnaire-based survey of community residents across China to assess knowledge of stroke symptoms and appropriate responses to suspected stroke events.

A total of 6181 residents were included in the final analysis, with 2037 living in Stroke Belt regions and 4144 in non-Stroke Belt regions. Overall, 19.07% (n = 1179) were unaware of any stroke symptoms, 17.96% (n = 1110) recognized one symptom, 11.97% (n = 740) recognized two symptoms, and 50.99% (n = 3152) recognized all three. Additionally, 77.59% (n = 4796) identified calling emergency medical services (EMS) as the correct response. Multivariable logistic regression showed that residents of the Stroke Belt had significantly lower odds of recognizing all three symptoms (adjusted odds ratio [aOR]: 0.50; 95% CI: 0.44-0.56; p < 0.001), calling EMS (aOR: 0.62; 95% CI: 0.54-0.70; p < 0.001), and both recognizing all three symptoms and calling EMS (aOR: 0.51; 95% CI: 0.45-0.58; p < 0.001).

Stroke action awareness remains notably low among community residents in China, with the lowest levels observed in the Stroke Belt. Targeted public health interventions are urgently needed to improve symptom recognition and promote timely action for emergency stroke care, especially in high-risk regions such as the Stroke Belt.