Faculty, Staff and Student Publications

Language

English

Publication Date

4-1-2025

Journal

Equity Neuroscience

DOI

10.1016/j.neuros.2025.100005

PMID

40994532

PMCID

PMC12456431

PubMedCentral® Posted Date

9-24-2025

PubMedCentral® Full Text Version

Author MSS

Abstract

Safety net hospitals (SNHs) provide care to patients regardless of their insurance status or ability to pay, serving populations at the highest risk for poor stroke outcomes. These include historically marginalized racial and ethnic groups, and individuals disproportionately affected by adverse social drivers of health, including lower socioeconomic status, housing instability, and limited access to preventive care. Improving stroke care at SNHs presents a critical opportunity to strengthen care delivery for individuals with the greatest need. However, such efforts require a clear understanding of the barriers across all levels of the healthcare system. In this Perspective, the authors adopt a socioecological framework to explore patient-, community-, institution-, and policy-level influences on stroke care in SNHs. Patient-level barriers include chronic disease burden, limited health literacy, and language barriers. Community-level challenges, such as neighborhood disadvantage, transportation challenges, and food insecurity, contribute to delays in care and recovery. At the institutional level SNHs often face inconsistent access to diagnostic imaging, limited specialty support, variation in stroke center certification, and staffing shortages. At the policy level, financing structures, documentation requirements, and performance metrics may unintentionally penalize under-resourced hospitals. Findings have been synthesized in this text across these domains and highlight opportunities for research, workforce development, and stroke care delivery improvement. A socioecological approach is essential to addressing disparities in stroke outcomes and guiding multilevel strategies that ensure consistent, high-quality care for underserved populations.

Keywords

Safety-net hospital, Stroke disparities, Stroke inequities, Public hospitals

Published Open-Access

yes

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