DOI: 10.23634/mmu.00631465
title: Health inequalities and stroke rapid literature review raw data

description: Health inequalities are unfair differences in health between different groups in society. We conducted a commissioned rapid review of the research literature of health inequalities and stroke as a first step to finding out what research exists on health inequalities across the stroke pathway, and we collated these studies. We systematically searched five electronic databases for peer reviewed journal articles in September 2022, restricted to studies from 2009 onwards. We included any studies that were about stroke survivors, their carers, or stroke clinicians that reported data on any aspect of health inequalities. We screened studies based on the country the research was from and agreed with Stroke Association to prioritise studies from the UK, expanding to Anglosphere countries, Western Europe and Japan (as a G7 country) where UK data were sparse on the topic area. USA studies were excluded due to major differences to UK healthcare. We categorised studies by four non-mutually exclusive focal lenses of health inequalities: 1. socioeconomic status (SES)/deprivation, 2. protected characteristics, 3. vulnerable groups (inclusion health groups such as migrants, asylum seekers, Gypsy, Roma and traveller communities, rough sleepers and unhoused people, sex workers, people in prison) and 4. geography (urban/rural/coastal communities), and by study topic e.g. thrombectomy, access to services, carers and by stages of the UK stroke care pathway. We conducted parallel Patient Carer and Public Involvement and Engagement (PCPIE) work including visiting six stroke groups across Greater Manchester (November and December 2022) to introduce the topic of health inequalities, discuss stroke survivor and carer priorities and build relationships. A panel of nine stroke survivors and carers met with us at the University/online (January 2023) to consider the findings from our review and contribute to the key messages and recommendations for the next steps for research. We identified 6179 studies from the database searches, and included 70 following screening by title, abstract, and full text. Forty-eight studies were from the UK. Most of the 70 studies, addressed inequalities from the lens of SES/deprivation or ethnicity. Despite a comprehensive search we did not identify any studies of stroke and under-served communities: migrants, asylum seekers, Gypsy, Roma and traveller communities, LGBTQ+ communities, neurodiverse communities, people with learning disabilities, sex workers, people in prison or other socially excluded groups. We identified five studies about urban/rural differences in geography but none relevant to coastal communities. We identified three studies about inequalities outside of the pre-specified lenses. Most studies (58) took a quantitative approach and almost one third (19/70) were epidemiological, about stroke incidence, prevalence or risk. We did not identify studies about inequalities in emotional or psychological support after stroke or return to work, which were priority areas for the stroke survivors we consulted with, and only found two studies reporting their own Patient Carer and Public Involvement and Engagement (PCPIE). Now that these 70 studies have been found and catalogued, critical appraisal of the quality of these studies is essential to know whether their findings can be implemented into practice or used to inform future research. Gaps in the data on inequalities and stroke could be reduced by partnership working with populations who are often not included in research. We strongly recommend all future studies are equipped to enable effective Patient, Carer and Public Involvement, which is rarely included in the research to date. Time, trust and collaboration are needed for researchers and healthcare providers to build meaningful relationships with community organisations that can facilitate engagement with under-served groups and tackle health inequalities. Community organisations will need resources, including long-term funding, and need to believe there is a genuine wish to change the model of co-working from a short-term, professional-led, approach to one that builds trust, ensures respect for values and leads to positive change for their communities.
description: Data extracted as part of a systematic review