Social and Geographic Determinants of Stroke: Disparities, Interventions, and Pathways to Equity Across the Stroke Care Continuum

Stroke remains a leading cause of death and disability worldwide, yet its burden is distributed unequally across populations and regions. Recent statements from the American Heart Association/American Stroke Association and the American Academy of Neurology emphasize that social determinants of health (including education, economic stability, access to care, neighborhood environment, insurance status, and structural racism) are major drivers of inequities in stroke risk, treatment, and outcomes. These inequities affect systemically marginalized populations, including racial and ethnic minorities, rural communities, people with low socioeconomic status, and other historically underserved groups.Recent epidemiologic evidence underscores the urgency of this topic. In the United States, stroke mortality has plateaued and, among younger adults, reversed after decades of decline, with increases closely linked to social deprivation, rural residence, low insurance coverage, and substance use. Globally, the burden of stroke remains disproportionately high in low- and middle-income countries, with marked geographic variation in incidence, mortality, and disability. Importantly, stroke risk is shaped by the cumulative effects of multiple adverse social determinants rather than by isolated factors alone. Cohort and national survey data show a strong dose-response relationship between the number of adverse social determinants and stroke incidence or prevalence.Geographic disparities further widen inequities across the stroke care continuum. Rural patients are less likely to receive acute evidence-based therapies such as thrombolysis and endovascular treatment, and they often experience worse outcomes. Persistent rural-urban gaps in stroke care reflect limited stroke center access, workforce shortages, and uneven health system capacity .Taken together, these data make a strong case for a dedicated Research Topic focused on how social and geographic determinants shape stroke prevention, acute care, rehabilitation, and long-term recovery.This Research Topic will provide a multidisciplinary forum for scholarship on the social and geographic determinants of stroke across the full care continuum. It will examine how structural, intermediate, and proximate determinants, such as socioeconomic status, race and ethnicity, insurance coverage, rural versus urban residence, regional disparities, and global context, influence stroke risk, access to care, outcomes, and recovery. The aims are to advance understanding of the social and geographic drivers of stroke disparities, evaluate interventions designed to reduce inequities, identify evidence gaps and implications for policy, systems change, and funding priorities, and promote equity as a central endpoint in stroke research and care.The issue will particularly encourage interdisciplinary, policy-relevant, and implementation-focused work, including studies of telehealth, mobile stroke systems, community-engaged research, and scalable models of care. Topics of interest include:-Epidemiology and mechanisms of social and geographic stroke disparities-Rural-urban, regional, and global inequities in stroke prevention, treatment, and rehabilitation-Interventions to reduce disparities across the stroke care continuum -Frameworks and methodological innovations for measuring and analyzing equity; policy, health systems, and workforce approaches to stroke equity-Community engagement, participatory research, implementation science, intersectionality, and emerging determinants such as environmental exposure, psychosocial stress, and digital inequitiesWe welcome Original Research, Systematic or Narrative Reviews, Perspectives, Methods, and Policy and Practice Reviews. Collectively, these contributions will help define actionable pathways toward equity in stroke research, care delivery, and policy. Topic editors: Gargya Malla, Akinkunmi Paul Okekunle, Dinesh Jillella Source: https://www.frontiersin.org/research-topics/79927/social-and-geographic-determinants-of-stroke-disparities-interventions-and-pathways-to-equity-across-the-stroke-care-continuum