Social Determinants of Health, Nursing Care Quality, and Patient Outcomes in Neurological Disorders: A Systematic Review.
Social Determinants of Health, Nursing Care Quality, and Patient Outcomes in Neurological Disorders: A Systematic Review.
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CN · Author affiliation · country only
Department of Nursing, Guang'an People's Hospital, Guang'an, Sichuan, People's Republic of China.Location evidence
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Original abstract
BACKGROUND: Social determinants of health (SDOH) significantly influence healthcare delivery and outcomes, yet their specific impacts on neurological nursing care quality remain insufficiently synthesized. OBJECTIVE: This systematic review aimed to synthesize evidence on the associations between SDOH and nursing care quality and patient outcomes across major neurological disorders. METHODS: Following PRISMA 2020 guidelines, we systematically searched PubMed, Web of Science, and Embase for observational studies published between January 2015 and October 2025. A narrative synthesis approach was employed due to substantial heterogeneity across studies. RESULTS: Sixty-five observational studies (2015-2025) encompassing 5,412,847 patients with stroke, dementia, Parkinson's disease, multiple sclerosis, epilepsy, and traumatic brain injury were included. Low socioeconomic status (SES) was associated with 39% increased stroke mortality and 36-66% higher rates of poor functional outcomes. Racial and ethnic minorities experienced 15-25% reduced access to acute stroke treatments and 27% higher readmission rates. Uninsured patients faced three-fold increased mortality and substantially reduced rehabilitation access, while rural patients received thrombolysis 50-55% less frequently. Optimal nurse staffing ratios (<3 patients per nurse) were associated with substantially reduced racial disparities in stroke readmissions, representing a critical modifiable nursing intervention. Educational attainment, income, occupation, and community deprivation demonstrated dose-response relationships with outcomes. CONCLUSION: Systematic SDOH screening integration, culturally tailored interventions, enhanced discharge planning, and policy advocacy addressing structural inequalities are essential to advance health equity in neurological nursing care. Nurse staffing optimization emerges as the most actionable strategy to reduce outcome disparities across vulnerable populations. Limitations include the observational nature of included studies, substantial heterogeneity in SDOH measurement, and geographic concentration in the United States.