Prognostic value of systemic and socioeconomic factors on stroke outcomes: narrative evidence review

Prognostication in acute stroke has traditionally centered on clinical and imaging predictors such as stroke severity, infarct volume, and reperfusion status. While indispensable for guiding acute management, these measures explain only part of the variability in recovery and long-term outcomes. Emerging evidence highlights those medical/systemic and socioeconomic determinants-namely cognition, frailty, comorbidity burden, mental health, social support, and financial resources-that play crucial yet often underrecognized roles in shaping stroke outcome and recovery trajectories. This review synthesizes multidisciplinary evidence linking systemic and socioeconomic factors with outcomes across the stroke care continuum. We argue that accurate prognostication must extend beyond anatomical and physiological variables to integrate patient context, capturing vitality, resilience, and social environment. Incorporating these factors into predictive models may enhance individualized care planning, improve trial design, and inform equitable health policy.