Black individuals in England are twice as likely to suffer a stroke as white people, according to the largest study of its kind, which also reveals that those from black African and Caribbean backgrounds face additional barriers to timely care and are more likely to experience the condition a decade earlier in life.
The analysis, conducted by researchers at King’s College London and presented at the European Stroke Organisation conference, draws on 30 years of data from the South London Stroke Register (SLSR). The register, one of the longest-running population-based stroke registers in the world, is unique because it records every single stroke occurrence in a defined geographical area rather than relying on clinical trial participants. Within a population of 333,000 people in Lambeth and Southwark, the study documented 7,726 strokes.
Overall stroke incidence fell by 34% between 1995-99 and 2010-14, but the trend then reversed: between 2020 and 2024, rates rose by 13%. During this most recent period, people from black African and black Caribbean backgrounds were more than twice as likely to experience a stroke compared with their white counterparts. Specifically, incidence was 131% higher among black African populations and 100% higher among black Caribbean populations.
Black stroke survivors also experienced the condition earlier. Those from black African backgrounds typically had their stroke 10 to 12 years before white patients. Furthermore, the study found that black African stroke survivors were 34% less likely to receive follow-up care on the NHS after a stroke. The period immediately after a stroke is critical for preventing a second event, leaving these patients at elevated risk for longer.
Underlying health risks and undiagnosed conditions
The researchers point to a cluster of biological and health-system factors behind the disparity. Black individuals are up to 47% more likely to have high blood pressure than white individuals, even after adjusting for socioeconomic background. Hypertension is a major risk factor, accounting for around half of all strokes. Studies cited in the research indicate that black people of African descent in the UK are three to four times more likely to have high blood pressure compared with white populations. Black individuals are also up to twice as likely to have diabetes, again after adjusting for socioeconomic factors.
Strikingly, 12% of black African patients had no diagnosed risk factors before their stroke, compared with 6.3% of white patients. This suggests significant gaps in early detection and management of conditions such as high blood pressure and diabetes within these communities.
The ethnic inequalities are most pronounced for intracerebral haemorrhage, a severe stroke subtype strongly linked to uncontrolled high blood pressure. Dr Camila Pantoja-Ruiz of King’s College London, the lead author, said: “Compared with other stroke types, intracerebral haemorrhage is more strongly associated with uncontrolled high blood pressure, which is more common in black communities.”
Delayed care, discrimination and the legacy of Covid
Beyond biological factors, the study highlights a range of systemic and social explanations for both the increased risk and the poorer outcomes. Dr Pantoja-Ruiz linked the recent rise in strokes partly to the Covid-19 pandemic. “This trend may partly reflect the lasting impact of the Covid-19 pandemic, which reduced access to primary care, blood pressure monitoring and prescribing, particularly affecting black and deprived communities,” she said. Research confirms that ethnic minority groups experienced a slightly larger fall in primary care consultations at the start of the pandemic and switched to telephone consultations at a higher rate, potentially reducing the quality of care.
She added: “These patterns of increased stroke risk in these communities may also be influenced by broader factors, including racism, unconscious bias and socioeconomic circumstances, which can impact access to and quality of care.”
The lower rate of follow-up care after a stroke is a particular concern. “Less timely follow-up leaves patients at elevated risk for longer and may be influenced by mistrust in healthcare services linked to historical and ongoing experiences of discrimination,” Dr Pantoja-Ruiz said. Studies show that ethnic minority patients often report mistrust and even discrimination within the NHS, and that unconscious bias can affect how symptoms are interpreted and what treatments are offered, leading to worse outcomes. Racial microaggressions, though subtle, can undermine patient well-being and contribute to healthcare disparities.
Even when blood pressure monitoring occurs, black patients are significantly less likely to achieve blood pressure control targets compared with white patients. This poorer control is particularly noted in African patients with diabetes and Caribbean patients with coronary heart disease.
Socioeconomic deprivation compounds the picture. The highest stroke incidence is observed among those experiencing deprivation, and lower socioeconomic status is consistently associated with disparities in care, increased post-stroke disability and mortality. Individuals from the lowest socioeconomic groups had strokes a median of seven years earlier than those from the highest. Lifestyle factors such as smoking, diet and exercise contribute significantly, but other dynamics are also at play — some studies suggest that black Caribbean people in the UK smoke less than their counterparts in Barbados, yet still have a higher stroke risk.
‘Progress is possible’ but action must be targeted
Maeva May, director of policy at the Stroke Association, said: “These findings reveal that stroke is rising again and that black African and black Caribbean communities are bearing a disproportionate burden. This rise is shaped by higher rates of undetected and under-treated risk factors for stroke, including high blood pressure – which is the cause of around half of all strokes – and diabetes. This is further exacerbated by the broader social and economic circumstances, such as poor housing, which shape health long before a stroke occurs.”
She stressed that the long-term decline in stroke rates between the 1990s and 2010s proves prevention can work. “We know that progress is possible – stroke rates have been falling over the last two decades, proving that prevention works when it reaches the people who need it. The challenge now is making sure that this support reaches everyone equally. The government must prioritise stroke and be guided by the voices of communities who are adversely affected by this life-changing condition.”