Social and Environmental Determinants of Stroke Functional Outcome and Strategies to Reduce Inequities: A Scientific Statement From the American Heart Association

Stroke is a leading cause of death and disability worldwide, and the recovery process is significantly influenced by a multitude of factors beyond immediate medical treatment. Social and environmental determinants of health-conditions in which people are born, grow, work, live, and age-play a crucial role in the functional outcomes of stroke survivors, and addressing these factors is essential to ensure equitable care and optimal recovery. Previous scientific statements have discussed the effects of social isolation on cardiovascular and brain health, as well as strategies to reduce racial and ethnic inequities in stroke preparedness, care, recovery, and risk factor control. In this statement, we review the effect of factors such as social and environmental determinants on stroke functional outcome primarily but also secondary stroke prevention when relevant. In addition, we provide actionable considerations for addressing them to improve stroke outcomes; strategies include the identification of upstream factors, use of impactful policies, and use of implementation science frameworks to translate evidence-based practices into real-world settings. Current gaps for future research include understanding the effect of cultural considerations on stroke recovery, recognizing the interaction of social and environmental determinants of health with each other and with biological factors in determining stroke outcomes, and finding effective ways to address these factors in different environments to achieve best outcomes for all stroke survivors.