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.

Keywords

aphasia - outcomes - intersectional analysis

Publikationsverlauf

Artikel online veröffentlicht:
26. September 2023

• References

• Aftonomos, L. B., Appelbaum, J. S., & Steele, R. D. (1999). Improving outcomes for persons with aphasia in advanced community-based treatment programs. Stroke, 30(7), 1370–1379
• American Speech Language Hearing Association. (2023). Aphasia. Accessed August 30, 2023 at: https://www.asha.org/practice-portal/clinical-topics/aphasia/
• Bambra, C. (2022). Placing intersectional inequalities in health. Health & Place, 75, 102761
• Barch, D. M., & Luby, J. L. (2023). Understanding social determinants of brain health during development. The American Journal of Psychiatry, 180(2), 108–110
• Blewett, L. A., Rivera Drew, J. A., Griffin, R., & Williams, K. C. W. (2019). IPUMS Health Surveys: Medical Expenditure Panel Survey, Version 1.1. doi: 10.18128/D071.V1.1
• Borod, J. C., Goodglass, H., & Kaplan, E. (1980). Normative data on the Boston Diagnostic Aphasia Examination, parietal lobe battery, and the Boston Naming Test. Journal of Clinical Neuropsychology, 2(3), 209–215
• Bowleg, L. (2012). The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health. American Journal of Public Health, 102(7), 1267–1273
• Bridges, K. M., Keel, T., & Obasogie, O. K. (2017). Introduction: critical race theory and the health sciences. American Journal of Law & Medicine, 43(2-3), 179–182
• Bronfenbrenner, U. (1979). The Ecology of Human Development: Experiments by Nature and Design. Cambridge, MA: Harvard University Press
• Cantor, M. N., & Thorpe, L. (2018). Integrating data on social determinants of health into electronic health records. Health Affairs (Project Hope), 37(4), 585–590
• Connor, L. T., Obler, L. K., Tocco, M., Fitzpatrick, P. M., & Albert, M. L. (2001). Effect of socioeconomic status on aphasia severity and recovery. Brain and Language, 78(2), 254–257
• Corus, C., & Saatcioglu, B. (2015). An intersectionality framework for transformative services research. Service Industries Journal, 35(7–8), 415–429
• Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, Volume 1989, Issue 1, Article 8, pp. 139-167.
• D'Amico, D., Amestoy, M. E., & Fiocco, A. J. (2022). The mediating role of allostatic load in the relationship between early life adversity and cognitive function across the adult lifespan. Psychoneuroendocrinology, 141, 105761
• Daniel, H., Bornstein, S. S., Kane, G. C., Carney, J. K., Gantzer, H. E., Henry, T. L., Lenchus, J. D., Li, J. M., McCandless, B. M., Nalitt, B. R., Viswanathan, L., Murphy, C. J., Azah, A. M., Marks, L., & the Health and Public Policy Committee of the American College of Physicians. (2018). Addressing social determinants to improve patient care and promote health equity: an American College of Physicians Position Paper. Annals of Internal Medicine, 168(8), 577–578
• Daniels, D. E., Boyle, M. P., & Archer, B. E. (2023). Stuttering, intersectionality, and identity: a qualitative analysis of the experiences of lesbian, gay, and bisexual individuals who stutter. Language, Speech, and Hearing Services in Schools, 54(1), 82–95
• Ellis, C. (2009). Does race/ethnicity really matter in adult neurogenics? American Journal of Speech-Language Pathology, 18(4), 310–314
• Ellis, C., Hardy, R. Y., & Lindrooth, R. C. (2017a). Greater healthcare utilization and costs among Black persons compared to White persons with aphasia in the North Carolina stroke belt. Journal of the Neurological Sciences, 376, 76–83
• Ellis, C., Hardy, R. Y., Lindrooth, R. C., & Peach, R. K. (2018). Rate of aphasia among stroke patients discharged from hospitals in the United States. Aphasiology, 32(9), 1075–1086
• Ellis, C., & Peach, R. K. (2017). Racial-ethnic differences in word fluency and auditory comprehension among persons with poststroke aphasia. Archives of Physical Medicine and Rehabilitation, 98(4), 681–686
• Ellis, C., Peach, R. K., Hardy, R. Y., & Lindrooth, R. C. (2017b). The influence of race on SLP utilisation and costs among persons with aphasia. Aphasiology, 31(12), 1433–1440
• Ellis, C., Phillips, R., Hill, T., & Briley, P. M. (2019). Social network structure in young stroke survivors with aphasia: a case series report. Seminars in Speech and Language, 40(5), 359–369
• Ellis, C., Simpson, A. N., Bonilha, H., Mauldin, P. D., & Simpson, K. N. (2012). The one-year attributable cost of poststroke aphasia. Stroke, 43(5), 1429–1431
• Fannin, D. K., Elleby, J., Tackett, M., & Minga, J. (2023). Intersectionality of race and question-asking in women after right hemisphere brain damage. Journal of Speech, Language, and Hearing Research: JSLHR, 66(1), 314–324
• Fotiadou, D., Northcott, S., Chatzidaki, A., & Hilari, K. (2014). Aphasia blog talk: How does stroke and aphasia affect a person's social relationships? Aphasiology, 28(11), 1281–1300
• Frederick, A., Jacobs, M., Adams-Mitchell, C. J., & Ellis, C. (2022). The global rate of post-stroke aphasia. Perspectives of the ASHA Special Interest Groups, 7(5), 1567–1572
• Frier, A., Barnett, F., & Devine, S. (2017). The relationship between social determinants of health, and rehabilitation of neurological conditions: a systematic literature review. Disability and Rehabilitation, 39(10), 941–948
• Gadson, D. S., Wesley, D. B., van der Stelt, C. M., Lacey, E., DeMarco, A. T., Snider, S. F., & Turkeltaub, P. E. (2022). Aphasia severity is modulated by race and lesion size in chronic survivors: a retrospective study. Journal of Communication Disorders, 100, 106270
• Gilmore, N., Fraas, M., & Hinckley, J. (2022). Return to work for people with aphasia. Archives of Physical Medicine and Rehabilitation, 103(6), 1249–1251
• González-Fernández, M., Davis, C., Molitoris, J. J., Newhart, M., Leigh, R., & Hillis, A. E. (2011). Formal education, socioeconomic status, and the severity of aphasia after stroke. Archives of Physical Medicine and Rehabilitation, 92(11), 1809–1813
• Guerrero-Arias, B. E., Agudelo-Orozco, A., & Pava-Ripoll, N. A. (2020). Intersectional identity chronotopes: expanding the disability experience. Disability & Society, 35(10), 1660–1681
• Harari, L., & Lee, C. (2021). Intersectionality in quantitative health disparities research: a systematic review of challenges and limitations in empirical studies. Social Science & Medicine, 277, 113876
• Hardy, R. Y., Lindrooth, R. C., Peach, R. K., & Ellis, C. (2019). Urban-rural differences in service utilization and costs of care for racial-ethnic groups hospitalized with poststroke aphasia. Archives of Physical Medicine and Rehabilitation, 100(2), 254–260
• Harris, J., Boehme, A., Chan, L., Moats, H., Dugue, R., Izeogu, C., Pavol, M. A., Naqvi, I. A., Williams, O., & Marshall, R. S. (2022). Allostatic load predicts racial disparities in intracerebral hemorrhage cognitive outcomes. Scientific Reports, 12(1), 16556
• Heinrich, C., Maffioli, A., & Vázquez, G. (2010). A Primer for Applying Propensity-Score Matching
• Hilal, S., & Brayne, C. (2022). Epidemiologic trends, social determinants, and brain health: the role of life course inequalities. Stroke, 53(2), 437–443
• Hinze, S. W., Lin, J., & Andersson, T. E. (2012). Can we capture the intersections? Older Black women, education, and health. Women's Health Issues, 22(1), e91–e98
• Holman, D., Salway, S., Bell, A., Beach, B., Adebajo, A., Ali, N., & Butt, J. (2021). Can intersectionality help with understanding and tackling health inequalities? Perspectives of professional stakeholders. Health Research Policy and Systems, 19(1), 97
• Hosman, F. L., Engels, S., den Ruijter, H. M., & Exalto, L. G. (2022). Call to action for enhanced equity: racial/ethnic diversity and sex differences in stroke symptoms. Frontiers in Cardiovascular Medicine, 9, 874239
• Jacobs, M., & Ellis, C. (2022). Racial disparities in post-stroke aphasia: a need to look beyond the base analysis. Journal of the National Medical Association, 114(3), 258–264
• Jacobs, M., & Ellis, C. (2023). Aphasianomics: estimating the economic burden of poststroke aphasia in the United States. Aphasiology, 37(1), 25–38
• Jacobs, M., Evans, E., & Ellis, C. (2023). Intersectional sociodemographic and neurological relationships in the naming ability of persons with post-stroke aphasia. Journal of Communication Disorders, 105, 106352
• Kelly, C., Dansereau, L., Sebring, J., Aubrecht, K., FitzGerald, M., Lee, Y., Williams, A., & Hamilton-Hinch, B. (2022). Intersectionality, health equity, and EDI: What's the difference for health researchers? International Journal for Equity in Health, 21(1), 182
• Khan, S. U., Acquah, I., Javed, Z., Valero-Elizondo, J., Yahya, T., Blankstein, R., Virani, S. S., Blaha, M. J., Hyder, A. A., Dubey, P., Vahidy, F. S., Cainzos-Achirica, M., & Nasir, K. (2022). Social determinants of health among non-elderly adults with stroke in the United States. Mayo Clinic Proceedings, 97(2), 238–249
• Kim, K. A., Lee, J. S., Chang, W. H., Kim, D. Y., Shin, Y.-I., Kim, S.-Y., Kim, Y. T., Kang, S. H., Choi, J. Y., & Kim, Y.-H. (2019). Changes in language function and recovery-related prognostic factors in first-ever left hemispheric ischemic stroke. Annals of Rehabilitation Medicine, 43(6), 625–634
• Klest, B. (2012). Childhood trauma, poverty, and adult victimization. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 245–251
• Labovitz, D. L. (2020). Stroke epidemiology and intersectionality: understanding stroke outcomes in Mexican Americans in Corpus Christi. Stroke, 51(10), 2886–2887
• Lazar, R. M., & Boehme, A. K. (2017). Aphasia as a predictor of stroke outcome. Current Neurology and Neuroscience Reports, 17(11), 83
• Lazar, R. M., Speizer, A. E., Festa, J. R., Krakauer, J. W., & Marshall, R. S. (2008). Variability in language recovery after first-time stroke. Journal of Neurology, Neurosurgery, and Psychiatry, 79(5), 530–534
• Le Dorze, G., Salois-Bellerose, É., Alepins, M., Croteau, C., & Hallé, M.-C. (2014). A description of the personal and environmental determinants of participation several years post-stroke according to the views of people who have aphasia. Aphasiology, 28(4), 421–439
• Lopez, N., & Gadsden, V. L. (2016). Health inequities, social determinants, and intersectionality. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. 10.31478/201612a
• Lwi, S. J., Herron, T. J., Curran, B. C., Ivanova, M. V., Schendel, K., Dronkers, N. F., & Baldo, J. V. (2021). Auditory comprehension deficits in post-stroke aphasia: neurologic and demographic correlates of outcome and recovery. [Original Research]. Frontiers in Neurology, 12, 680248
• Magwood, G. S., Ellis, C., Nichols, M., Burns, S. P., Jenkins, C., Woodbury, M., & Adams, R. (2019). Barriers and facilitators of stroke recovery: perspectives from African Americans with stroke, caregivers and healthcare professionals. Journal of Stroke and Cerebrovascular Diseases, 28(9), 2506–2516
• McEwen, B. S. (2000). Allostasis, allostatic load, and the aging nervous system: Role of excitatory amino acids and excitotoxicity. Neurochemical Research, 25(9-10), 1219–1231
• McEwen, B. S. (2006). Protective and damaging effects of stress mediators: central role of the brain. Dialogues in Clinical Neuroscience, 8(4), 367–381
• Merlo, J. (2018). Multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) within an intersectional framework. Social Science & Medicine, 203, 74–80
• Miller, H. L., Thomi, M., Patterson, R. M., & Nandy, K. (2022). Effects of intersectionality along the pathway to diagnosis for autistic children with and without co-occurring attention deficit hyperactivity disorder in a nationally-representative sample. Journal of Autism and Developmental Disorders. (Advance online publication.) doi: 10.1007/s10803-022-05604-0
• Mirman, D., Strauss, T. J., Brecher, A., Walker, G. M., Sobel, P., Dell, G. S., & Schwartz, M. F. (2010). A large, searchable, web-based database of aphasic performance on picture naming and other tests of cognitive function. Cognitive Neuropsychology, 27(6), 495–504
• Mochari-Greenberger, H., Xian, Y., Hellkamp, A. S., Schulte, P. J., Bhatt, D. L., Fonarow, G. C., Saver, J. L., Reeves, M. J., Schwamm, L. H., & Smith, E. E. (2015). Racial/Ethnic and sex differences in emergency medical services transport among hospitalized US stroke patients: analysis of the national get with the Guidelines-Stroke Registry. Journal of the American Heart Association, 4(8), e002099
• Mossakowski, K. N. (2003). Coping with perceived discrimination: Does ethnic identity protect mental health? Journal of Health and Social Behavior, 44(3), 318–331
• Baciu A, Negussie Y, Geller A, et al. eds.; National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; Communities in Action: Pathways to Health Equity. Washington, DC: National Academies Press (US); 2017 January 11. 2, The State of Health Disparities in the United States. Accessed August 30, 2023 at: https://www.ncbi.nlm.nih.gov/books/NBK425844/
• National Aphasia Association. (2022). 2022 Aphasia Awareness Survey. Accessed August 30, 2023 at: https://www.aphasia.org/2022-aphasia-awareness-survey/
• Nguy, B., Quique, Y. M., Cavanaugh, R., & Evans, W. S. (2022). Representation in aphasia research: an examination of U.S. treatment studies published between 2009 and 2019. American Journal of Speech-Language Pathology, 31(3), 1424–1430
• Nicolas, G., de la Fuente, M., & Fiske, S. T. (2017). Mind the overlap in multiple categorization: a review of crossed categorization, intersectionality, and multiracial perception. Group Processes & Intergroup Relations, 20(5), 621–631
• Office of Disease Prevention and Health Promotion. (n.d.). Social determinants of health. Healthy People 2030. U.S. Department of Health and Human Services. https://health.gov/healthypeople/objectives-and-data/social-determinants-health
• O'Halloran, R., Renton, J., Harvey, S., McSween, M.-P., & Wallace, S. J. (2023). Do social determinants influence post-stroke aphasia outcomes? A scoping review. Disability and Rehabilitation, 1–14; doi: 10.1080/09638288.2023.2193760
• Park, Y., Mulligan, N., Gleize, M., Kristiansen, M., & Bettencourt-Silva, J. H. (2022). Discovering associations between social determinants and health outcomes: merging knowledge graphs from literature and electronic health data. AMIA ... Annual Symposium Proceedings - AMIA Symposium. AMIA Symposium, 2021, 940–949.
• Reshetnyak, E., Ntamatungiro, M., Pinheiro, L. C., Howard, V. J., Carson, A. P., Martin, K. D., & Safford, M. M. (2020). Impact of multiple social determinants of health on incident stroke. Stroke, 51(8), 2445–2453
• Schehter, I., Schejter, J., Abarbanel, M., Koren, R., Mendelson, L., Ring, H., & Becker, E. (1985). Sex and aphasic syndromes. Scandinavian Journal of Rehabilitation Medicine. Supplement, 12, 64–67
• Seng, J. S., Lopez, W. D., Sperlich, M., Hamama, L., & Reed Meldrum, C. D. (2012). Marginalized identities, discrimination burden, and mental health: Empirical exploration of an interpersonal-level approach to modeling intersectionality. Social Science & Medicine, 75(12), 2437–2445
• Sharma, S., Briley, P. M., Wright, H. H., Perry, J. L., Fang, X., & Ellis, C. (2019). Gender differences in aphasia outcomes: evidence from the AphasiaBank. International Journal of Language & Communication Disorders, 54(5), 806–813
• Simmonds, K. P., Luo, Z., & Reeves, M. (2021). Race/Ethnic and stroke subtype differences in poststroke functional recovery after acute rehabilitation. Archives of Physical Medicine and Rehabilitation, 102(8), 1473–1481
• Sundet, K. (1988). Sex differences in severity and type of aphasia. Scandinavian Journal of Psychology, 29, 168–179
• Thornton, R. L., Glover, C. M., Cené, C. W., Glik, D. C., Henderson, J. A., & Williams, D. R. (2016). Evaluating strategies for reducing health disparities by addressing the social determinants of health. Health Affairs (Project Hope), 35(8), 1416–1423
• Torregosa, M. B., Sada, R., & Perez, I. (2018). Dealing with stroke: perspectives from stroke survivors and stroke caregivers from an underserved Hispanic community. Nursing & Health Sciences, 20(3), 361–369
• Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., Commodore-Mensah, Y., Elkind, M. S. V., Evenson, K. R., Eze-Nliam, C., Fugar, S., Generoso, G., Heard, D. G., Hiremath, S., Ho, J. E., . . . Martin, S. S., & the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2023). Heart Disease and Stroke Statistics - 2023 update: a report from the American Heart Association. Circulation, 147(8), e93–e621
• Veenstra, G. (2011). Race, gender, class, and sexual orientation: intersecting axes of inequality and self-rated health in Canada. International Journal for Equity in Health, 10(1), 3
• Warner, D. F., & Brown, T. H. (2011). Understanding how race/ethnicity and gender define age-trajectories of disability: an intersectionality approach. Social Science & Medicine, 72(8), 1236–1248
• Wertz, R. T., Auther, L. L., & Ross, K. B. (1997). Aphasia in African-Americans and Caucasians: severity, improvement, and rate of improvement. Aphasiology, 11(4–5), 533–542
• World Health Organization. (2023). Social determinants of health. Accessed August 30, 2023 at: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
• Worrall, L. E., Hudson, K., Khan, A., Ryan, B., & Simmons-Mackie, N. (2017). Determinants of living well with aphasia in the first year poststroke: a prospective cohort study. Archives of Physical Medicine and Rehabilitation, 98(2), 235–240
• Yadav, R. S., Chaudhary, D., Avula, V., Shahjouei, S., Azarpazhooh, M. R., Abedi, V., Li, J., & Zand, R. (2022). Social determinants of stroke hospitalization and mortality in United States' counties. Journal of Clinical Medicine, 11(14), 4101