McCarthy Stephen, McMeekin Peter, Allen Michael, James Martin, Laws Anna, McCarthy Andrew, McClelland Graham, Moseley Lisa, Park Laura, Phillips Daniel, Price Christopher, Scott Jason, Shaw Lisa, White Phil, Wilson David, Ford Gary A
Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK.
Medical School, University of Exeter, Exeter EX1 2LU, UK.
Healthcare (Basel). 2025 Jun 12;13(12):1410. doi: 10.3390/healthcare13121410.
There are a lot of advances that may affect the way treatment is delivered prehospital, including mobile stroke units and point-of-care diagnostics. These have the potential to affect populations differently and therefore affect the distribution of health outcomes.
We aimed to address the following research questions: (1) Which geographic and socioeconomic inequalities have been included when evaluating access to acute stroke treatment (including reperfusion therapies)? (2) How have the identified measures been considered/assessed/calculated? (3) We also report any methodological approaches that have been proposed that might further improve the way in which acute stroke care interventions are analysed, specified relating to inequalities.
PubMed and Scopus electronic databases were searched for studies that included participants who underwent acute stroke treatment and included quantitative measures of geographic and/or socioeconomic inequalities or inequities in accessing/receiving treatment.
Overall, sixty-six studies were included in the review. Fifty-nine included at least one measure of geographic inequalities or inequities while thirty-six included at least one measure of socioeconomic inequalities or inequities. Twenty-eight of these studies included both a geographic and socioeconomic measure of inequalities or inequities. There were no commonalities in the methods of defining, categorising and measuring the inequalities or inequities. No study provided their definition of inequality or inequity or stated any normative judgements they had made.
It is vital that the evaluation of programmes like acute stroke care consider impacts on inequality and inequity. Researchers and policy makers should work together to determine relevant measures of inequality/inequity and the most appropriate methods of measuring and categorising them. In addition, researchers should make it clear within their work how they are defining inequality and inequity and what (if any) normative judgements have been made.
有许多进展可能会影响院前治疗的提供方式，包括移动卒中单元和即时诊断。这些进展有可能对不同人群产生不同影响，进而影响健康结果的分布。
我们旨在解决以下研究问题：（1）在评估急性卒中治疗（包括再灌注治疗）的可及性时，纳入了哪些地理和社会经济不平等因素？（2）已确定的衡量标准是如何被考虑/评估/计算的？（3）我们还报告了任何可能进一步改进急性卒中护理干预措施分析方式的方法学途径，具体涉及不平等问题。
在PubMed和Scopus电子数据库中检索研究，这些研究纳入了接受急性卒中治疗的参与者，并包括地理和/或社会经济不平等或在获得/接受治疗方面的不公平性的定量衡量标准。
总体而言，该综述纳入了66项研究。59项研究纳入了至少一项地理不平等或不公平性的衡量标准，而36项研究纳入了至少一项社会经济不平等或不公平性的衡量标准。其中28项研究同时纳入了地理和社会经济不平等或不公平性的衡量标准。在定义、分类和衡量不平等或不公平性的方法上没有共性。没有研究提供其对不平等或不公平性的定义，也没有说明他们做出的任何规范性判断。
至关重要的是，对急性卒中护理等项目的评估应考虑对不平等和不公平性的影响。研究人员和政策制定者应共同努力，确定不平等/不公平性的相关衡量标准以及衡量和分类这些标准的最合适方法。此外，研究人员应在其工作中明确说明他们如何定义不平等和不公平性，以及做出了哪些（如果有的话）规范性判断。
