SEQUINS State of Science (SoS) Lecture: Is Looking Upstream and Downstream Enough to Address Inequities in Post-Stroke Outcomes? Digging Deeper Midstream

Background The study of stroke inequities has placed a greater emphasis on the social determinants of health and the contributions of individual, societal and healthcare system factors that influence outcomes. There is concern that attempts to carefully consider these factors may result in some disconnection between the three areas resulting in less emphasis on the individual contributors Purpose This is an invited paper based on the Society for Equity Neuroscience SEQUINS State of Science (SoS) Lecture in July 2026. Methods The author draws on research in cardiovascular and cerebrovascular studies focused on Black Americans to highlight the importance of examining the duration and development of risk factors to better understand disparities in post-stroke outcomes. Results Evidence in both the cardiovascular and cerebrovascular literature suggests racial differences in risk factor development that begins as early as adolescence among Black Americans when compared to White Americans. Little attention has been given to early onset risk factor development among Black Americans in relationship to early onset of stroke. This is concerning given that Black Americans also face worse stroke outcomes and experience shorter lifespans. Conclusions Novel approaches to studying inequities in stroke outcomes must consider the connections between individual, societal, and healthcare system contributors to differential outcomes while also exploring the unique pathways to stroke that Black Americans may experience.