WHERE ONE LIVES, HOW ONE FALLS ILL: SOCIAL AND TERRITORIAL FACTORS ASSOCIATED WITH STROKE IN BRAZIL

Abstract

This chapter discusses the social and territorial factors associated with the occurrence and mortality of stroke in Brazil, with emphasis on socioeconomic, racial, regional, and healthcare access inequalities. It is a theoretical-reflective study based on a narrative review of recent scientific literature and relevant institutional documents, including Brazilian epidemiological studies, spatial analyses, and international reports on social determinants of health. The synthesis shows that stroke remains an important public health problem in the country, even in the presence of partial declines in mortality over time, and that its distribution follows gradients of income, education, race, population aging, health infrastructure, and territorial accessibility to care. The findings indicate that municipalities and regions with worse socioeconomic conditions tend to present higher mortality rates, while geographic, urban, and organizational barriers restrict timely access to acute stroke care. In addition, inequalities in the supply of specialized services, urban mobility, and the quality of health information reinforce the persistence of inequities in outcomes. It is concluded that reducing the burden of stroke in Brazil depends on integrating risk-factor prevention, strengthening primary health care, regionalizing urgent care, improving health information systems, and structurally addressing social and territorial inequalities. The analysis reaffirms the centrality of the Brazilian Unified Health System as a redistributive policy and highlights the need to incorporate equity as an organizing axis of stroke care pathways.