Key Summary
- Although diabetes rates increased for all ethnic groups over the three decades, it was more rapid among Black African participants
- People from Black African heritage more likely to experience stroke without a prior risk factor diagnosis than other ethnic groups.
- The prevalence of diabetes was 23% higher in participants with routine or manual occupations, compared with those in non-routine or non-manual occupations.
People from Black African and Caribbean heritage are more vulnerable to stroke risk factors, including high blood pressure and diabetes, than their white counterparts, according to a King’s College London analysis.
The research, published in eClinicalMedicine, analysed data from more than 8,500 adults over 30 years as part of the South London Stroke Register – one of the longest-running population-based stroke registers in the world.
About one in six people across the UK will have a stroke in their lifetime, and those from Black African heritage were more likely to experience stroke without a prior risk factor diagnosis than other ethnic groups.
Although diabetes rates increased for all ethnic groups over the three decades, it was more rapid among Black African participants, rising from 21% between 1995 and 2004 to 41% between 2015 and 2024.
Diabetes was about twice as common in Black Caribbean and Black Africans on the stroke register compared with white participants.
As for high blood pressure, it was 29% more prevalent in Black Caribbean and 47% more prevalent in Black African people.
Socio-economic disparities
While diabetes diagnoses increased in all socioeconomic groups over time, but the greatest increases were seen in those with routine and manual jobs and with lower education levels. Similarly, hypertension rates increased the most in those with lower socioeconomic status.
The prevalence of diabetes was 23% higher in participants with routine or manual occupations (such as bus drivers, security guards and plumbers) compared with those in non-routine or non-manual occupations (such as teachers, nurses, engineers and police officers), and 21% higher in those with lower education levels.
Diverse register
The South London Stroke Register recruited participants from Southwark and Lambeth in South London, two of London’s most diverse boroughs.
Over the 30-year study period, the South London population also became larger and more ethnically diverse, enabling researchers to examine how changes in population demographics have influenced inequalities in stroke risk factors over time.
Increase prevention efforts: Researcher
Lead author Dr Eva Emmett, Research Fellow at King’s College London, 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.
“In terms of prevention, NHS Health Checks, which screen for hypertension and diabetes, begin at the age of 40. However, this may be too late for higher-risk groups who often experience stroke at a younger age.
“There needs to be both universal improvements in cardiovascular risk detection and more targeted prevention strategies – such as younger screening age for those most at risk – to reduce widening inequalities in stroke incidence and improve long-term health outcomes.”
