Stroke risk factors including high blood pressure and diabetes are rising faster among people from Black African and Caribbean backgrounds compared with their white counterparts, according to analysis by researchers at King's College London.
The study, based on data from more than 8,500 adults over a 30-year period from the South London Stroke Register, found that while the prevalence of stroke risk factors increased faster among Black people, those from Black African backgrounds were also twice as likely to experience a stroke without a prior risk factor diagnosis than white people, at a rate of 12% compared with 6%. About one in six people across the UK will have a stroke in their lifetime.
Diabetes and hypertension disparities
Diabetes was about twice as common in Black Caribbean and Black African participants on the stroke register compared with white participants, and high blood pressure was 29% more prevalent in Black Caribbean and 47% more prevalent in Black African people. Although diabetes rates increased for all ethnic groups over the 30-year study period, they increased most rapidly among Black African participants, rising from 21% between 1995 and 2004 to 41% between 2015 and 2024.
Dr Eva Emmett, a research fellow at King's College London and lead author of the study, said: “Our study shows that the 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 age at stroke and higher likelihood of having a stroke without a prior risk factor diagnosis, these findings call for targeted and earlier primary prevention efforts.”
Need for earlier screening
Emmett noted that NHS health checks, which screen for hypertension and diabetes, begin at age 40. However, this may be too late for higher-risk groups who often experience stroke at a younger age. She called for “universal improvements in cardiovascular risk detection” as well as more targeted prevention strategies, such as younger screening age for those most at risk.
The data also revealed socioeconomic disparities. The prevalence of diabetes was 23% higher in participants with manual occupations, such as bus drivers, security guards and plumbers, compared with those in non-manual employment such as teachers and nurses. Diabetes prevalence was also 21% higher in those with lower education levels. While diabetes diagnoses increased in all socioeconomic groups over time, the greatest increases were seen in those with routine and manual jobs and with lower education levels. Similarly, high blood pressure rates increased the most in those with lower socioeconomic status.
Call for targeted prevention
Dr Maëva May, director of policy at the Stroke Association, said the findings were a stark reminder that “the benefits of prevention are not being felt equally”. “Too many people from Black African and Black Caribbean communities, and those living in more deprived circumstances, are developing stroke risk factors earlier and are experiencing stroke before those risks have even been identified,” May said. “Stroke is not inevitable. Many strokes can be prevented by finding and treating conditions like high blood pressure and diabetes early, but that only works if people can access the right care at the right time. Preventing stroke means preventing inequalities in who gets the opportunity to stay well.”
