Stroke. 2023 Jul;54(7):e371-e388. doi: 10.1161/STR.0000000000000437. Epub 2023 May 15.
Stroke is a disease of disparities, with tremendous racial and ethnic inequities in incidence, prevalence, treatment, and outcomes. The accumulating literature on the relationship between stroke and social determinants of health (ie, the structural conditions of the places where people live, learn, work, and play) contributes to our understanding of stroke inequities. Several interventions have been tested concurrently to reduce racial and ethnic inequities in stroke preparedness, care, recovery, and risk factor control. It is regrettable that no common theoretical framework has been used to facilitate comparison of interventions. In this scientific statement, we summarize, across the stroke continuum of care, trials of interventions addressing racial and ethnic inequities in stroke care and outcomes. We reviewed the literature on interventions to address racial and ethnic inequities to identify gaps and areas for future research. Although numerous trials tested interventions aimed at reducing inequities in prehospital, acute care, transitions in care, and poststroke risk factor control, few addressed inequities in rehabilitation, recovery, and social reintegration. Most studies addressed proximate determinants (eg, medication adherence, health literacy, and health behaviors), but upstream determinants (eg, structural racism, housing, income, food security, access to care) were not addressed. A common theoretical model of social determinants can help researchers understand the heterogeneity of social determinants, inform future directions in stroke inequities research, support research in understudied areas within the continuum of care, catalyze implementation of successful interventions in additional settings, allow for comparison across studies, and provide insight into whether addressing upstream or downstream social determinants has the strongest effect on reducing inequities in stroke care and outcomes.
中风是一种存在巨大种族和民族差异的疾病，在发病率、患病率、治疗和结果方面存在巨大差异。关于中风与健康社会决定因素（即在人们生活、学习、工作和娱乐的地方的结构条件）之间关系的积累文献有助于我们了解中风的不平等现象。已经同时测试了几种干预措施，以减少中风准备、护理、康复和危险因素控制方面的种族和民族不平等。遗憾的是，没有使用共同的理论框架来促进干预措施的比较。在本科学声明中，我们总结了贯穿中风护理各个方面的试验，这些试验针对中风护理和结果方面的种族和民族不平等问题。我们回顾了关于干预措施的文献，以确定解决中风护理中种族和民族不平等问题的差距和未来研究领域。尽管许多试验测试了旨在减少院前、急性护理、护理过渡和中风后危险因素控制方面不平等的干预措施，但很少有研究涉及康复、恢复和社会重新融入方面的不平等。大多数研究都涉及近端决定因素（例如，药物依从性、健康素养和健康行为），但上游决定因素（例如，结构性种族主义、住房、收入、粮食安全、获得护理）没有得到解决。社会决定因素的共同理论模型可以帮助研究人员了解社会决定因素的异质性，为中风不平等研究的未来方向提供信息，支持护理连续体中未充分研究领域的研究，促进在其他环境中成功实施干预措施，允许对研究进行比较，并深入了解解决上游或下游社会决定因素对减少中风护理和结果方面的不平等现象是否有更强的效果。
