A recent study conducted by researchers at King’s College London has shed new light on the relationship between ethnicity and stroke risk, revealing that differences in traditional stroke risk factors, such as diabetes and high blood pressure, are the primary drivers of stroke risk, rather than ethnicity itself.
Examining the South London Population
The study’s findings indicate that individuals of Asian and Black ethnicity are more prone to developing conditions like diabetes and hypertension than their white counterparts, but once these conditions are present, the likelihood of experiencing a stroke is comparable across all ethnic groups.
The research, published in BMC Public Health, drew on primary care electronic records from over 650,000 individuals in south London, collected from 41 general practices in Lambeth between 2005 and 2021. The study focused on three key risk factors for stroke: hypertension, diabetes, and hypercholesterolemia, and included patients from Asian, Black, and white ethnic backgrounds.
To investigate the relationship between ethnicity, cardiometabolic risk factors, and stroke, the researchers employed a multistate analysis, a modeling technique that enables the examination of how individuals progress through different health states over time. By using this method, the researchers were able to calculate the probability of individuals transitioning from one health state to another.
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Disparities in the Development of Risk Factors
The study’s results confirmed that the occurrence of stroke risk factors is higher among Black and Asian patients than among white patients. Ethnicity was found to be significantly associated with the development of all three stroke risk factors, particularly diabetes and hypertension. Compared to white patients, Black patients were approximately twice as likely to develop hypertension and more than twice as likely to develop diabetes, while Asian patients were around 50% more likely to develop hypertension and three times as likely to develop diabetes.
Similar Outcomes Following Risk Factor Onset
However, when the researchers examined the transition from stroke risk factor to stroke itself, they found that the patterns of disparity disappeared. Among patients with hypertension or diabetes, the probability of progressing to stroke was similar across all ethnic groups. As Dr. Marc Delord, research fellow in medical statistics at King’s College London, noted, “We know that stroke occurs more frequently in some ethnic groups. Our study explains that these inequalities are attributable to traditional modifiable cardiometabolic risk factors only: Although Black and Asian patients were more likely to develop these risk factors, particularly hypertension and diabetes, once these conditions are present, their subsequent probability of stroke was not higher than that of white patients.”
Need for Targeted Interventions
Dr. Marc Delord, research fellow in medical statistics at King’s College London, said, “Our findings reinforce the need for prevention, detection and management strategies that account for the higher burden of these modifiable risk factors observed in Black and Asian populations, including culturally tailored lifestyle interventions, to help reduce inequalities in stroke risk.”
Notably, the study found that hypercholesterolemia did not follow the same pattern as the other risk factors. Among Black patients with hypercholesterolemia, there was a slight increase in the subsequent likelihood of stroke compared to white patients. The authors suggest that this finding warrants further investigation, particularly in light of previous research indicating that Black patients with hypercholesterolemia are less likely to receive statin treatment.