Rising stroke rates highlight widening ethnic and socioeconomic inequalities across populations, major study finds
(Wednesday, 6 May, Maastricht, The Netherlands) A new study presented today at the European Stroke Organisation Conference (ESOC) 2026 shows that after decades of decline, stroke incidence is rising again, driven by higher rates in some ethnic minority populations and concentrated among socioeconomically disadvantaged groups.1
These 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.2
These findings come from the South London Stroke Register (SLSR), one of the longest-running population-based stroke registers in the world. Unlike hospital audits or clinical trials, 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.
Sustaining this infrastructure for 30 years has required long-term commitment and funding, and the depth of insight it generates, including the inequalities documented here, would not be possible without that continuity.
This 30-year analysis 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 (Incidence Rate Ratio [IRR] 2.31; 95% CI 2.03–2.62) and Black Caribbean (IRR 2.00; 95% CI 1.73–2.31) 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.3
Lead researcher, Dr Camila Pantoja-Ruiz from King’s College London, commented, “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.”
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.4, 5 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,” said 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.1, 6
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 adjusting for 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.7
“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.1 These findings highlight the need for earlier prevention and targeted interventions.
According to Dr Pantoja-Ruiz, these findings are relevant to diverse urban populations worldwide. “While the specific mechanisms differ between healthcare systems, a consistent finding is that prevention is not reaching those most at risk. Worsening cardiovascular inequalities have been reported across many settings, and these findings add to growing evidence that this is a widespread problem requiring targeted solutions.”
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Note to editors:
A reference to ESOC 2026 must be included in all coverage and/or articles associated with this study.
For more information or to arrange an expert interview, please contact press@eso-stroke.org
About the study author:
Dr Camila Pantoja-Ruiz is a PhD candidate at the Stroke Research Group, King's College London. With a background in clinical neurology, her research focuses on health inequalities in stroke, combining traditional epidemiological methods with causal modelling to generate evidence that can inform policies to reduce inequalities in stroke risk, care, and outcomes across diverse populations.
About the South London Stroke Register and the Stroke Research Group:
The SLSR was established in 1995 and is one of the longest-running population-based stroke registers in the world. It is led by Dr Iain Marshall at the Stroke Research Group at King's College London, which brings together clinicians, epidemiologists, and public health researchers dedicated to understanding and reducing the burden of stroke across diverse populations. The SLSR investigates risk, short- and long-term outcomes after stroke and the quality of care provided. More information about the team and their work can be found at: https://www.kcl.ac.uk/research/stroke-research-group
About the European Stroke Organisation (ESO):
The ESO is a pan-European society of stroke researchers and physicians, national and regional stroke societies and lay organisations that was founded in December 2007.
The aim of the ESO is to reduce the burden of stroke by changing the way that stroke is viewed and treated. This can only be achieved by professional and public education, and by making institutional changes. ESO serves as the voice of stroke in Europe, harmonising stroke management across the whole of Europe and taking action to reduce the burden of stroke regionally and globally.
References:
- Pantoja-Ruiz, C, Khanolkar, A.R., Ismail, I., et al. (2026) ‘Widening ethnic inequalities in stroke incidence: A 30-year population-based analysis of the South London Stroke Register’, European Stroke Organisation Conference (ESOC) 2026, oral presentation.
- Bereda, G. (2025) ‘Demographic disparities in stroke occurrence: Insights from an integrative review of emerging trends’, Brain and Behavior.
- Pantoja-Ruiz, C., Akinyemi, R. and Lucumi-Cuesta, D.I., et al. (2024) ‘Socioeconomic status and stroke: A review of the latest evidence on inequalities and their drivers’, Stroke, 56(3), pp. 794–805.
- Emmett, E.S., Pantoja-Ruiz, C., Lim, E., et al. (2026) ‘Ethnic and socioeconomic inequalities in pre-stroke vascular risk factor profiles: The South London Stroke Register 1995–2024’, European Stroke Organisation Conference (ESOC) 2026, poster presentation.
- Bhaskaran, K., Bacon, S., Evans, S.J.W., et al. (2021) ‘Factors associated with deaths due to COVID-19 versus other causes: Population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform’, The Lancet, 398(10316), pp. 2168–2181.
- Rajashekar, D. and Liang, J.W. (2023) ‘Intracerebral hemorrhage’, in StatPearls. Treasure Island (FL): StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK553103/
- Ismail, I., Pantoja-Ruiz, C., Lim, E., et al. (2026) ‘Determinants of general practitioner follow-up after stroke: The South London Stroke Register’, European Stroke Organisation Conference (ESOC) 2026, poster presentation.