Living with Carotid Artery Stenosis: A Qualitative Study on the Role of the Social Determinants of Health

Carotid artery stenosis (CAS) is a major cause of ischemic stroke, yet little is known about how social determinants of health (SDHs) shape patients’ experiences beyond biomedical risk factors. This qualitative study explored how individuals living with CAS perceive the influence of SDHs across their illness trajectory. Semi-structured interviews were conducted with 30 adults receiving care at two Italian vascular surgery units. Data were analyzed using reflexive thematic analysis, guided deductively by the Centers for Disease Control and Prevention (CDC) five-domain SDH framework. Participants described CAS as an experience embedded within broader social conditions rather than solely a vascular disease. Economic resources influenced access to healthcare, healthy lifestyles, and treatment adherence; fragmented healthcare pathways, geographical barriers, and limited continuity of care complicated disease management; health literacy shaped understanding of the disease and engagement in self-management; neighborhood characteristics affected opportunities for prevention and physical activity; and family and community support represented essential resources for coping and navigating healthcare. These determinants interacted throughout the illness trajectory rather than operating independently. The findings indicate that effective CAS management extends beyond clinical treatment and requires integrating SDH assessment into routine vascular care to support person-centered management, strengthen treatment engagement, and reduce health inequalities.