The Intersection of Social Determinants of Health and Post-stroke Aphasia Outcomes: A Need for Intersectional Analysis

Abstract

Aphasia is a disorder that results from damage to portions of the brain that are responsible for language and can vary significantly by type and severity. Differences in aphasia outcomes are influenced by the social determinants of health (SDOH). The SDOH are structural, environmental, and personal determinants that influence health outcomes. Intersectionality, or how one's social and political identities interact to influence individual life outcomes and/or advantage in our society, provides a way to examine the varying levels of the SDOH. However, intersectionality is complex, difficult to measure, and has not yet been explored in post-stroke aphasia outcomes. This article reviews the relationship of race and aphasia outcomes and the SDOH and aphasia outcomes. Additionally, we provide a novel current approach to examine the SDOH and aphasia outcomes. Lastly, we discuss the need for evaluation of intersectionality in aphasia and aim to provide a leveled social–ecological framework to examine aphasia-related outcomes. With notable individual differences among aphasia outcomes, we present a framework to support optimizing research and clinical aphasia care in speech-language pathology.

Intersectionality in Aphasia Services for Ethnosocially Diverse Adult Populations

“…Next, Centeno (2024) describes intersectional LPAA-based strategies, grounded in personal storytelling, to collect the input that can inform culturally responsive intervention in ethnosocially diverse aphasia caseloads in the United States. Finally, Evans et al (2024) propose a socioecological model to evaluate the impact of intersecting individual, environmental, and structural determinants of health on aphasia outcomes, especially in vulnerable populations.…”

Exploring the association between social determinants and aphasia impairment: A retrospective data integration approach

“…In previous work we have suggested that any exploration of disparities in aphasia outcomes must carefully explore not only the SDOH but also studies designed with an intersectional lens of inquiry [ 18 ]. Intersectional approaches are utilized to explain how differing lived experiences translate into differences in clinical outcomes [ 19 ].…”

“…Intersectional approaches begin with careful consideration of childhood and how the early lived experience translate synergistically over to time and the influence of any geographic inequities that impact health over during the lifespan [ 20 ]. Most previous work in aphasia examining the association between social determinants and aphasia impairment have not evaluated the SDOH through an intersectional framework despite evidence that the SDOH often work synergistically to impact health outcomes [ 18 ].…”