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A Systematic Review and Meta-analysis of Ethnic Inequalities in Stroke Incidence Patterns and Trends in High-Income Countries (2015-2025).
This systematic review and meta-analysis looked at studies from 2015 to 2025 reporting first-ever stroke incidence by ethnicity in adults in high-income c…
Signal score64Research triage score
CertaintyModerateVerify in full text
PMID42228643Source identifier
Research triage, not medical advice
Do not use this summary, score, or benefit-cost estimate to diagnose, treat, prescribe, or change care without reviewing the full study and consulting qualified professionals.
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Check full-text methods, eligibility, outcomes, risk of bias, harms, conflicts, funding, replication, and applicability.
Plain-English signal
This systematic review and meta-analysis looked at studies from 2015 to 2025 reporting first-ever stroke incidence by ethnicity in adults in high-income countries. It found that ethnic minority groups continue to have higher rates of stroke than majority groups. For example, pooled data from North America showed higher stroke incidence among Black compared with White populations. Long-running registries in the US, UK, Australia (Aboriginal and Torres Strait Islander peoples), and New Zealand (Māori) showed persistent and in some cases widening gaps. Adjusting for socioeconomic status and cardiovascular risk factors reduced but did not eliminate these inequalities, suggesting other causes (including structural and upstream determinants) also play a role. The authors conclude that better detection and treatment of risk factors is necessary but not sufficient; reducing disparities will require investigation of upstream drivers and population-based prevention that addresses structural barriers. They also note a lack of evidence from low- and middle-income countries.
Why it matters
- Disease: Stroke - stroke is a leading cause of death and disability; changes in incidence by ethnicity affect public health planning and resource allocation.
- Exposure / Population: Ethnic minority populations in high-income countries (Black, Aboriginal and Torres Strait Islander, Māori, Hispanic/Latino, Asian and Middle Eastern) - persistent or widening incidence gaps indicate inequities in prevention, detection, or care.
- Intervention / Policy relevance: Findings bear on the likely insufficient impact of clinical risk-factor management alone (e.g., hypertension and diabetes control) and the need for upstream, population-level or structural interventions.
- Outcome: First-ever stroke incidence trends - informs prevention prioritization, surveillance, and equity-targeted programs.
- Geography / Setting: High-income countries - relevant for health systems and policy makers in settings with similar sociodemographic and health-system contexts.
Primary outcomes
- First-ever stroke incidence by ethnicity
Effect summary
Abstract-reported findings: Across 26 publications (22 studies) in high-income countries, Black populations in the US had higher stroke incidence than White populations (pooled incidence rate ratio 1.62, 95% CI 1.18-2.22). Aboriginal and Torres Strait Islander peoples in Australia and Māori in New Zealand showed two- to threefold excess incidence. Asian, Middle Eastern, and Hispanic/Latino populations showed heterogeneous patterns. Adjusting for socioeconomic status and cardiovascular risk factors only partially attenuated inequalities.
Benefit-cost lens
| Quick take | This systematic review shows persistent ethnic inequalities in stroke incidence in high-income countries, with pooled evidence of higher incidence among Black versus White populations in North America. Translating this into programmatic benefit requires absolute risks, numbers affected, intervention effectiveness by group, and cost data. |
|---|---|
| BCR anchor | 2 |
| Time horizon | 3 |
| Discount rate | 0.03 |
| Assumptions | Assessment based only on PubMed metadata and abstract; full-text verification needed to confirm methods, absolute rates, subgroup definitions, and detailed bias assessments before any cost-effectiveness or implementation estimates. |
Benefit-cost fields are assumptions-based unless explicitly source-derived. Treat them as prompts for deeper economic review.
Risk of bias
| Tool | ROBINS-E referenced in abstract; rapid abstract-based synthesis |
|---|---|
| Verdict | Some concerns |
| Notes | Abstract reports mixed study quality: 5 studies low risk, 6 some concerns, 12 high or very high risk of bias. The rapid triage used only metadata and abstract; a full-text ROBINS-E assessment is required to confirm domain-level bias and impact on pooled estimates. Heterogeneity and potential confounding remain concerns per abstract. |
Harms, equity, conflicts & implementation
| Implementation | Full-text review to extract absolute incidence rates, subgroup definitions, study periods, and methods; local population denominators; stakeholder engagement with affected communities; cost and capacity estimates for targeted prevention programs; and monitoring for unintended consequences. |
|---|---|
| Equity impact | High potential equity relevance: the review documents persistent and sometimes widening ethnic disparities in stroke incidence. Specific impact depends on local population composition, access barriers, and whether upstream determinants are addressed. |
| Harms | Abstract does not report harms. Potential harms of equity-targeted interventions (e.g., resource shifts, unintended stigmatization) are not addressed in the abstract and require full-text and context-specific assessment. |
| Replication | Unknown from abstract; replication would require re-extraction and reanalysis of included studies from full texts. |
Source links — verify original
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