Widening Ethnic Inequalities in Stroke Incidence: A 30-Year Population-Based Analysis of the South London Stroke Register

Aim/backgroundEthnic inequalities in stroke incidence are well-established, but long-term trends and the impact of socioeconomic status (SES) remain understudied. We estimated incidence rates by ethnicity over 30-years, and differences by SES, using the South London Stroke Register (1995-2024). MethodsWe conducted a population-based study including all residents of a geographically defined area of South London, calculating standardised incidence rates using census-derived denominators and the 2013 European Standard Population. The area-level Index of Multiple Deprivation was the indicator of SES. Poisson regression estimated incidence rate ratios comparing ethnic-minority vs White groups, adjusting for age, sex, and SES, with ethnicity-SES interaction testing and marginal rates derived by subgroup. ResultsAmong 7,726 people with first-ever stroke, overall standardised incidence decreased 34% between 1995-1999 and 2010-2014 (198;[187.8-208] to 131;[122.4-138.9] per 100,000), then increased 13% in 2020-2024. Black-African and Black-Caribbean populations had higher baseline incidence persisting across all periods. Ethnic inequalities narrowed initially but subsequently widened, with incidence twice as high in Black-African (IRR=2.31;[2.03-2.62]) and Black-Caribbean (IRR=2.00;[1.73-2.31]) groups compared to White groups in 2020-2024. Patterns were consistent across stroke subtypes, with the largest inequalities in primary intracerebral haemorrhage. Ethnic differences in incidence attenuated on SES adjustment but remained significant. Within ethnic groups, most deprived Black-African and Black-Caribbean populations showed highest incidence. ConclusionStroke incidence has risen sharply in the past five years, driven by rising incidence rates in Black-African and Black-Caribbean populations, with reduction in the White population. Achieving equity requires ensuring uptake of cardiovascular risk programmes across all socioeconomic and ethnic groups, with earlier risk management for groups who develop stroke 10-12 years younger than the general population.