Black participants had significantly lower stroke knowledge scores than White participants (median 8.5 vs. 11.0, p <0.001), after adjusting for various factors.
Is Black race associated with lower stroke knowledge compared to White race in patients with acute stroke syndrome?
Black patients with acute stroke syndrome have significantly lower stroke knowledge than White patients, independent of education and socioeconomic status, highlighting a disparity that may contribute to prehospital delays.
Introduction: Stroke education is a key determinant of timely hospital arrival. While considerable evidence indicates that Black patients experience greater prehospital delay, few studies have investigated whether these gaps extend to stroke knowledge. Methods: Time is Brain is a multicenter, prospective, observational study investigating social, psychological, and demographic determinants of prehospital delay. Demographics, clinical characteristics, and stroke knowledge were collected from patients with acute stroke syndrome presenting to two tertiary care centers in the Northeast. Stroke knowledge was assessed through a validated 19-item stroke knowledge test. A Mann-Whitney U test was performed to compare stroke knowledge scores between Black and White participants of any ethnicity. Rank-based median regression was then used to evaluate the association between race and stroke knowledge while adjusting for sex, age, education level, cognitive status, socioeconomic status (SES), NIH Stroke Scale (NIHSS) and healthcare distrust. Results: A total of 321 patients with acute stroke syndrome were enrolled between January 2023 and July 2025 (mean age = 66.30, SD = 15.64, 43.9% Female, median NIHSS = 2). A total of 60 participants (19%) self-identified as Black and 240 as White (75%). All other racial groups were underpowered for statistical analysis (n<5). Stroke knowledge was non-normal (Shapiro-Wilk p <0.001, skewness=-0.85, kurtosis=0.53). In the unadjusted analysis, Black participants had significantly lower stroke knowledge scores than White participants (median IQR 8.5 6.25-11.0 vs. 11.0 9.0-13.0, p <0.001). In the adjusted median regression model, Black race was significantly associated with lower stroke knowledge scores (β = -2.35, 95% CI -3.60, -1.10, p =0.002), independent of sex, age, education level, cognitive status, SES, NIHSS and healthcare distrust. In this model, fewer years of education completed (β = 0.24 0.07,0.41, p <0.01) and lower cognitive status scores (β = -0.11 -0.20,-0.02, p =0.020) were also associated with lower stroke knowledge. Conclusion: In this multicenter cohort, Black participants had significantly lower stroke knowledge than White participants, a difference that remained significant when adjusting for demographic, educational, and clinical factors. This difference warrants further investigation into the underlying causes and potential interventions to improve stroke knowledge in Black patients.
Johnson et al. (2026) studied this question. Black participants had significantly lower stroke knowledge scores than White participants (median 8.5 vs. 11.0, p <0.001), after adjusting for various factors.