Black people consistently had a higher rate of stroke than white people over a recent 22-year period, according to a study published in Neurology, which also found that the average age of Black people experiencing stroke was nearly 10 years younger than that of white people, another inequity that grew over time.

“We found that the rate of stroke is decreasing over time in both Black and white people—a very encouraging trend for US prevention efforts,” says study author Tracy E. Madsen, MD, PhD, of Brown University, in a release. “But there was an inequity from the beginning of the study, with the rate of stroke always being higher for Black people than their white counterparts. The disparity did not decrease in 22 years, especially among younger and middle-aged adults.”

Researchers evaluated stroke trends over time using data from hospitals in southern Ohio and northern Kentucky from 1993 to 2015. Stroke cases were recorded across a full year every five years—about 1,950 cases per year for a total of 9,728. Using US Census data, they were able to calculate stroke incidence rates per 100,000 people.

The overall rate of stroke decreased from 230 cases per 100,000 people in 1993 to 188 cases per 100,000 people in 2015. For Black people, the rates went from 349 to 311, and for white people they declined from 215 to 170.

The rate of stroke among Black people continued to be 50 to 80% higher than the rate among white people across the 22 years, even after adjusting for age and sex—a disparity that was particularly stark in younger and middle-aged Black adults. The disparity shrank in older age groups, a difference the researchers say may be due to different survival rates in Black and white people.

While the rate of stroke was decreasing, the study found that strokes were occurring at younger ages over time, and this change was larger in Black people, exacerbating an existing disparity. Strokes struck Black people at an average age of 66 at the beginning of the study and at age 62 by the end of the study. For white people, the average age was 72 at the beginning of the study and 71 two decades later.

“These disparities present a major ongoing public health concern,” Madsen says in a release. “More work is clearly needed to address systemic and policy problems, as well as factors at the provider and patient levels. These findings are a clear, urgent call for concrete efforts to build more equitable means of stroke prevention and care.”

Madsen noted a limitation of the study was that while race was the primary focus of the study, the key social factors that contribute to racial inequities, like systemic racism and access to preventative care, were not measured. 

The study was supported by the National Institute of Neurological Disorders and Stroke.

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