Key result
Black African ethnicity is linked to ~47% higher pre-stroke hypertension prevalence versus White ethnicity.
Why the study?
Ethnic minority and lower socioeconomic groups experience higher stroke incidence, but long-term trends in vascular risk factor prevalence, management, and whether socioeconomic inequalities explain ethnic inequalities remained unclear.
Cohort (n=8,515)
Answers are grounded in this paper and cite their sources.
Ethnic minority and lower socioeconomic groups have a higher and faster-increasing prevalence of pre-stroke hypertension and diabetes, highlighting the need for targeted and earlier primary prevention efforts.
Background Ethnic minority and lower socioeconomic groups experience higher stroke incidence. This study investigates long-term trends of inequalities in vascular risk factor prevalence and management, and whether socioeconomic inequalities explain ethnic inequalities. Methods 8515 participants of the population-based South London Stroke Register cohort (1995–2024) were stratified by ethnicity (62.4% White, 15.5% Black Caribbean, 13.3% Black African), occupation (60.7% routine/manual), education (44.6% lower education), and stroke year (1995–2004, 2005–2014, 2015–2024). The impact of ethnicity, occupation and education on risk factor diagnoses and prescribed treatments was estimated using Poisson regression models. Findings 12.0% of strokes in Black African participants (median age 59.0 years) occurred without pre-stroke risk factor diagnosis (White participants: 6.3%, median age 74.1 years). Black and lower socioeconomic groups had higher rates of hypertension (adjusted prevalence ratio: Black Caribbean vs White: 1.29 [95% CI: 1.20–1.34], Black African: 1.47 [1.40–1.53], manual/routine vs non-routine/non-manual occupation: 1.09 [1.05–1.13], lower vs higher education: 1.06 [1.02–1.11]) and diabetes (Black Caribbean: 2.23 [2.04–2.43], Black African: 1.92 [1.73–2.13], manual/routine: 1.23 [1.13–1.34], lower education: 1.21 [1.09–1.37]) but lower rates of atrial fibrillation (Black Caribbean: 0.57 [0.48–0.68], Black African: 0.66 [0.54–0.82], lower education: 0.78 [0.68–0.91]). Over time (1995–2024), ethnic and socioeconomic inequalities widened for diabetes and hypertension but narrowed for atrial fibrillation. 36% of strokes occurred in people with diagnosed, but untreated risk factors. Treatment rates were not associated with occupation or education, but Black participants had higher treatment rates for hypertension and diabetes. Adjusting for occupation or education had negligible impact on associations between ethnicity and risk factor diagnosis or treatment. Interpretation Prevalence of pre-stroke hypertension and diabetes is higher and increasing faster in ethnic minority and lower socioeconomic groups. Together with Black people's younger stroke age and higher likelihood of having stroke without prior risk factor diagnosis, these findings call for targeted and earlier primary prevention efforts. Funding This project is funded by the National Institute for Health and Care Research (NIHR) under its Programme Grants for Applied Research (NIHR202339).
No takes yet. Share an insight, caveat, or question.
Emmett et al. (2026) conducted a cohort in Stroke (n=8,515). Ethnic minority and lower socioeconomic status vs. White ethnicity and higher socioeconomic status was evaluated on Hypertension prevalence (Black African vs White) (PR 1.47, 95% CI 1.40-1.53). Black African ethnicity was associated with a higher prevalence of pre-stroke hypertension compared to White ethnicity, with inequalities widening over time.
Synapse has enriched 10 related papers. Consider them for comparative context: