Addressing health inequities in stroke care : a critical review of health inequities in stroke care and interpretive description of the experiences of young women survivors

Health disparities, inequalities and inequities exist in stroke care and outcomes. Growing evidence has focused on examining disparities related to singular social identities/positions (e.g., sex and gender only) instead of the influence of multiple intersecting systems of power (e.g., sexism, classism) and how these produce advantages and disadvantages experienced by persons diagnosed with a stroke/stroke survivors. Among these survivors are young women, who, despite experiencing increasing stroke incidence and distinct experiences, have received little attention. This study sought to identify gaps in health services and make recommendations to develop high-quality, equitable systems of care for young women stroke survivors in British Columbia, Canada. A three-step approach included: 1) a critical integrative review of health disparities, inequalities and inequities in stroke care using a modified integrative review methodology with an intersectionality approach; 2) the development of a Young Women Stroke Survivorship Collaborative deploying the principles of Integrated Knowledge Mobilization; and 3) an Interpretive Description study drawing on nursing’s epistemology and critical models to explore and explain how intersecting systems of power shape young women’s stroke survivorship and care in British Columbia. The critical integrative review examined 471 records and 392 conference proceedings published over a 34-year period (1991-2024). Most (60.1%) originated in the United States and reported on race and/or ethnicity (59.9%), and sex and (cis)gender disparities (43.7%). Disparities related to geographic location, migrants, transients and refugees, persons experiencing homelessness, sexual and gender minorities, and persons with substance use disorder were rarely reported. Only 14.9% of studies applied intersectional analyses, and 3.2% used a qualitative methodology. In the Interpretive Description study, interviews with 21 young women, a focus group with 5 family members/caregivers, and 9 stroke expert interviews demonstrated how young women stroke survivors pay a high ‘disability tax’. The web of disability, age, sex, gender, and socioeconomic position, against the backdrop of existing stroke rehabilitation models and social protection policies, creates inequities in young women’s stroke survivorship experiences and access to stroke care. The cumulative and compounding social, economic, psychological and structural impacts experienced by young women offer exemplars of age-based deficit-lens, structural sexism, structural classism and structural ableism in stroke care.