Health Disparities, Inequalities and Inequities in Stroke Care: A Global Critical Integrative Review (1991-2024).

Abstract

Growing evidence demonstrates the impact of health disparities on stroke care and outcomes. Although reviews have examined disparities related to sex and gender, race and ethnicity, socioeconomic status and rural-urban residence, most have not accounted for the influence of multiple intersecting social identities or positions. This critical integrative review used a modified integrative review methodology with an intersectionality approach. We reported bibliographic trends and generated Upset Plots to analyze intersections among categories of social identity/position. Analysis was iterative to identify patterns and relationships between and within categories. We included 471 records and 392 conference proceedings published over 34 years (1991-2024). Most studies (60.1%) were from the United States and included only individuals with ischemic stroke (48.8%). A total of 59.9% reported on race and/or ethnicity disparities, followed by 43.7% on sex and (cis)gender. Studies focused on geography, migrants, transients and refugees, individuals experiencing homelessness, sexual and gender minorities, and individuals with substance use disorder were lacking. The largest set of studies reporting on at least 2 categories was the combination of race and/or ethnicity, sex and cis(gender) and age. Only 68 (14.9%) quantitative studies conducted intersectional analyses, with the largest intersection being race and/or ethnicity with sex and (cis)gender. Studies often used a unidimensional approach to social identities or positions and focused on identifying and quantifying disparities, with minimal consideration of their intersecting nature and explanatory drivers. Studies on how disparities are experienced by individuals living with stroke were rare. To advance health equity in stroke care and research, studies using an intersectionality framework are needed.