Top Things to Know: Social & Environmental Determinants of Stroke Functional Outcome and Strategies to Reduce Inequities
Updated: May 11, 2026
Prepared by Maggie Eaton, PhD, RN, Science and Medicine Advisor, American Heart Association
- Social, economic, and environmental determinants of health play a major but underrecognized role in shaping stroke functional outcomes and recovery.
- Advances in acute stroke care alone are insufficient to eliminate disparities in recovery, as inequities in stroke functional outcome and secondary stroke prevention persist due to upstream, non-clinical factors.
- Sex and gender may be associated with differences in stroke functional outcomes, but additional research into sex- and gender-specific stroke risk and recovery is needed.
- Race and ethnicity, as social constructs, may be associated with disparities in stroke functional outcomes and secondary prevention, which could reflect differences in access to care, insurance coverage, comorbid conditions, social support, cultural factors, and structural inequities.
- Socioeconomic status, insurance status, education, health literacy and occupation may be associated with stroke recovery and recurrence risk, with strong evidence for greater socioeconomic resources, higher levels of education, and greater health literacy being linked to better outcomes.
- Psychosocial factors, cultural beliefs, and language barriers may affect stroke recovery and secondary stroke prevention; addressing factors such as stress and ensuring access to appropriate mental health resources may support improved recovery and outcomes.
- Environmental factors, including rural versus urban residence, neighborhood safety, the built environment, and access to healthy foods, may shape both functional recovery and secondary stroke prevention, contributing to persistent inequities across populations.
- Strategies to address social and environmental determinants include adapting care delivery based on identified social risks, such as translation services, telehealth, and flexible clinic structures, and directly addressing unmet social needs through screening, culturally tailored education, and referral to community resources.
- Sustained improvements in stroke recovery and secondary prevention depend on organizational capacity, equitable implementation based on need, and supportive community and policy infrastructure, without which patient-level interventions are unlikely to be effective or durable.
Citation
Nelson SE, El Husseini N, Bahouth MN, Fleming TK, Harvey RL, Hayman LL, Raghavan P; on behalf of the American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Lifestyle and Cardiometabolic Health; and Council on Quality of Care and Outcomes Research. Social and environmental determinants of stroke functional outcome and strategies to reduce inequities: a scientific statement from the American Heart Association. Stroke. Published online May 11, 2026. doi: 10.1161/STR.0000000000000520