Fornari Arianna, Lanza Martina, Guastafierro Erika, Marcassoli Alessia, Sismondo Pietro, Curatoli Chiara, Raggi Alberto, Leonardi Matilde
Neurology, Public Health, and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Eur J Neurol. 2025 Jan;32(1):e16553. doi: 10.1111/ene.16553. Epub 2024 Nov 25.
Health disparities and inequities are an important and too long overlooked public health concern worldwide. These differences in health and health care can affect people with any disease, including neurological disorders. The aim of this systematic review is to provide an updated overview of the main health inequities faced by neurological patients worldwide, to plan valuable interventions.
Main databases were searched systematically. Quality was assessed with the Mixed Methods Appraisal Tool. This review followed the standard guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
A total of 1797 studies were obtained, of which 49 studies were included in the final round and subjected to quality appraisal. Quality assessment yielded scores ranging from 20% to 100%. The results were divided based on the nature of inequities: (i) socioeconomic disadvantage (n = 25); and (ii) access to care, treatment, and services inequities (n = 24). Most studies were conducted in high income counties (n = 46, 93.8%) and reported health inequities in persons with cerebrovascular diseases, especially stroke (n = 20, 40.8%), followed by multiple sclerosis (n = 8, 16.3%) and neurodegenerative disorders (n = 6, 12.2%).
Racial and ethnic discrimination, economic issues, differences in disease management, educational level, and place of residence are the main inequities reported by neurological patients. The USA dominates the research panorama (n = 36, 73.4%), highlighting the need for more studies that cover other geopolitical contexts. Improving population health means improving health for everyone; however, historically disadvantaged groups continue to trail dramatically behind, and actions are needed to reduce the inequities.
健康差异与不平等是全球范围内一个重要且长期被忽视的公共卫生问题。这些健康及医疗方面的差异会影响患有任何疾病的人群，包括神经系统疾病患者。本系统综述的目的是提供全球神经疾病患者所面临的主要健康不平等状况的最新概述，以便规划有价值的干预措施。
对主要数据库进行了系统检索。使用混合方法评估工具对质量进行评估。本综述遵循系统评价与荟萃分析的首选报告项目的标准指南。
共获得1797项研究，其中49项研究纳入最终轮次并进行质量评估。质量评估得分在20%至100%之间。结果根据不平等的性质进行划分：（i）社会经济劣势（n = 25）；（ii）获得医疗、治疗和服务的不平等（n = 24）。大多数研究在高收入国家进行（n = 46，93.8%），报告了脑血管疾病患者的健康不平等情况，尤其是中风（n = 20，40.8%），其次是多发性硬化症（n = 8，16.3%）和神经退行性疾病（n = 6，12.2%）。
种族和民族歧视、经济问题、疾病管理差异、教育水平和居住地点是神经疾病患者报告的主要不平等因素。美国在研究领域占主导地位（n = 36，73.4%），这凸显了需要开展更多涵盖其他地缘政治背景的研究。改善人群健康意味着改善每个人的健康；然而，历史上处于劣势的群体仍远远落后，需要采取行动减少不平等。
