King's College London

The findings reflect broader patterns seen in diverse urban populations internationally, pointing to widening health inequalities and highlighting an urgent need to improve uptake of cardiovascular risk programmes across all socioeconomic and ethnic groups.

These findings come from the South London Stroke Register (SLSR), one of the longest-running population-based stroke registers in the world. The SLSR is led by Dr Iain Marshall in the Stroke Research Group at King's College London.

The SLSR recruits every person with a first-ever stroke within a geographically defined, ethnically diverse area of South London, and investigates how stroke affects communities over time, including people who may never reach specialist care.

The 30-year analysis, presented at ESOC 2026 by lead researcher Dr Camila Pantoja-Ruiz from King’s, examined how the risk of having stroke varied in different ethnic and socioeconomic groups in a population of 333,000 people in South London, of whom 7,726 had a stroke. After a 34% decrease between 1995–1999 and 2010–2014 (from 198 to 131 cases per 100,000 people), the risk of stroke increased by 13% in 2020–2024.

Although overall trends initially improved, the recent rise was not evenly distributed. In 2020–2024, stroke incidence was more than twice as high in Black African and Black Caribbean populations compared with the White population.

Rates remained consistently higher in these groups across the study period, with the highest incidence observed among those experiencing socioeconomic deprivation. These patterns are consistent with evidence from other high-income settings.

Compared with White participants, Black African and Black Caribbean populations were more likely to have high blood pressure (47% and 29% higher prevalence, respectively) and diabetes (92% and 123% higher, respectively), both of which increase stroke risk. Notably, 12% of Black African patients had no diagnosed risk factors prior to stroke, compared with 6.3% of White patients, suggesting gaps in early detection.

“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,” added Dr Pantoja-Ruiz.

Ethnic inequalities were greatest for intracerebral haemorrhage, a severe and often fatal subtype of stroke, with disparities between Black African, Black Caribbean and White populations being more pronounced than for other stroke subtypes.

Dr Pantoja-Ruiz explained that this may be due to differences in underlying risk factors: “Compared with other stroke types, intracerebral haemorrhage is more strongly associated with uncontrolled high blood pressure, which is more common in Black communities.”

Dr Pantoja-Ruiz stated that these inequalities persisted even after taking into account clinical severity, socioeconomic status and other clinical factors. Additional analyses found that Black stroke survivors, particularly Black African survivors, were less likely to receive timely follow-up care, with Black African survivors having 34% lower odds of follow-up.

“The period immediately after a stroke is critical for preventing another,” added Dr Pantoja-Ruiz. “Interventions such as controlling blood pressure, optimising medication and identifying other vascular risks are essential. 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.”

Additionally, Black African populations were found to experience stroke around 10–12 years earlier than White populations on average. These findings highlight the need for earlier prevention and targeted interventions, the researchers say.