Inequities in neurological care: Access to services, care gaps, and other barriers—A systematic review

Abstract

BACKGROUND AND PURPOSE: Health disparities and inequities are an important and too long overlooked public health concern worldwide. These differences in health and health care can affect people with any disease, including neurological disorders. The aim of this systematic review is to provide an updated overview of the main health inequities faced by neurological patients worldwide, to plan valuable interventions. METHODS: Main databases were searched systematically. Quality was assessed with the Mixed Methods Appraisal Tool. This review followed the standard guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS: A total of 1797 studies were obtained, of which 49 studies were included in the final round and subjected to quality appraisal. Quality assessment yielded scores ranging from 20% to 100%. The results were divided based on the nature of inequities: (i) socioeconomic disadvantage (n = 25); and (ii) access to care, treatment, and services inequities (n = 24). Most studies were conducted in high income counties (n = 46, 93.8%) and reported health inequities in persons with cerebrovascular diseases, especially stroke (n = 20, 40.8%), followed by multiple sclerosis (n = 8, 16.3%) and neurodegenerative disorders (n = 6, 12.2%). CONCLUSIONS: Racial and ethnic discrimination, economic issues, differences in disease management, educational level, and place of residence are the main inequities reported by neurological patients. The USA dominates the research panorama (n = 36, 73.4%), highlighting the need for more studies that cover other geopolitical contexts. Improving population health means improving health for everyone; however, historically disadvantaged groups continue to trail dramatically behind, and actions are needed to reduce the inequities.

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