Effect of language on heart attack and stroke awareness among US hispanics

Background: Hispanics with acute heart attack or stroke have longer delay times to hospital arrival, and are thus less likely to benefit from time-dependent reperfusion therapies. Delay time is influenced largely by recognition of warning symptoms and activation of the 911 system. Previous studies suggest poor symptom recognition among racial/ethnic minorities, but very little is known about heart attack and stroke knowledge among Hispanics, or the influence of English language proficiency on cardiovascular emergency awareness. Methods: Cross-sectional analysis (conducted in 2005) of data from the 2003 Behavioral Risk Factor Surveillance System population survey was limited to states with Spanish-language interviews. Principal study outcomes were the correct identification of five heart attack and five stroke warning symptoms, and intention to call 911 for a suspected event. Subjects included 698 English-speaking Hispanics, 527 Spanish-speaking Hispanics, and 24,201 non-Hispanics. Results: Spanish-speaking Hispanics are far less likely to know all heart attack symptoms (7%) than English-speaking Hispanics (23%), non-Hispanic blacks (28%), and non-Hispanic whites (39%) (p < 0.001); and far less likely to know all stroke symptoms (18%) than English-speaking Hispanics (31%), non-Hispanic blacks (41%), and non-Hispanic whites (50%) (P < 0.001). Intention to call 911 did not differ significantly among groups. Spanish-speaking Hispanics remain significantly less likely than all other groups to correctly identify symptoms after adjustment for sociodemographic characteristics, healthcare access, and cardiovascular risk factors (p < 0.05). Conclusions: Lack of English proficiency is strongly associated with lack of heart attack and stroke knowledge among Hispanics. This highlights the need for educational intervention about cardiovascular emergencies targeted to Spanish-speaking communities.