Health inequalities in stroke outcomes across the COVID-19 pandemic: a meta-analysis

This meta-analysis examined the association between health disparities and stroke outcomes across the pre-COVID-19 and during-COVID-19 periods. A systematic search of PsycINFO, PubMed, Scopus, and Web of Science identified relevant studies published between 1 January 2019 and 31 December 2024. Fourteen studies met the inclusion criteria. Random-effects meta-analysis demonstrated a significant moderate positive association between health disparities and stroke outcomes ( r = 0.34, 95%CI [0.22, 0.45]). Subgroup analyses showed significant associations across study design, COVID-19 period, and country setting categories, although subgroup differences were not statistically significant. In contrast, significant between-group differences were observed according to disparity type, with the strongest associations identified for healthcare access, racial, socioeconomic, and healthcare utilization disparities. Meta-regression analyses indicated that publication year and country economic group did not significantly explain between-study variability. Overall, the findings suggest that health disparities were consistently associated with poorer stroke outcomes across diverse healthcare contexts, highlighting the importance of addressing structural and socioeconomic inequities in stroke care and public health preparedness.