Abstract Number: Esoc2026a1853 a Systematic Review and Meta-Analysis of Ethnic Inequalities in Stroke Incidence Patterns and Trends (2015–2025)

Abstract Background and aims Stroke incidence overall has been falling,but systematic information on ethnic inequality trends is missing.We aimed to systematically review last decade literature to describe these trends globally. Methods We systematically reviewed observational studies published between 2015-2025 reporting first-ever-stroke-incidence by ethnic group in adults globally. We searched MEDLINE, Embase, and Scopus;assessed risks of bias using ROBINS-E,and reported following PRISMA 2020.Random-effects meta-analysis was conducted for all-stroke incidence in Black vs White populations. Results Twenty-six publications from 22 studies were included,all from high-income-countries. Five studies were rated at low-risk of bias, the rest had some concerns due to exposure measurement and limited case-ascertainment. Black populations in the US experienced higher stroke incidence vs White populations(pooled RR=1.62; 95%-CI 1.18-2.22),with inequalities widening over the last decade in the US and the UK.Aboriginal and Torres Strait Islander peoples in Australia and Māori in New Zealand showed two-to threefold excess incidence (RRs ~2–3; 95%- CIs spanning 1.3–6.0), with widening inequalities. Asian and Middle Eastern populations in Europe and North America showed heterogeneous patterns.Hispanic/Latino populations in the US had similar or lower incidence than non-Hispanic-White populations. Adjustment for socioeconomic status and cardiovascular risk factors only partially reduced these inequalities. Conclusions Ethnic inequalities in stroke incidence are widening for some populations in high-income countries globally. Reducing inequalities requires better detection and treatment of hypertension and diabetes, investigation of unmeasured drivers,and population-based.There is a priority need for evidence from low-and middle-income countries where stroke burden is highest and ethnic diversity greatest. Conflict of interest Camila Pantoja-Ruiz: Nothing to disclose