Observational multistate analysis attributes ethnic stroke gaps to hypertension and diabetes incidence, not progression
Large observational electronic-record study using multistate modeling shows ethnic stroke inequalities in south London are explained by differential rates of hypertension and diabetes onset, not by higher stroke risk once those factors are present. Results support culturally tailored prevention focused on detection and control rather than ethnicity-specific stroke biology. Evidence quality is moderate: large sample, real-world data, but residual confounding and incomplete recording of lifestyle factors remain possible.
The study separated two transitions: risk-factor acquisition and progression from risk factor to stroke. Ethnicity strongly predicted the first transition (Black patients HR ~2.0 for hypertension, >2.0 for diabetes; Asian patients ~1.5 and 3.0 respectively) but showed no independent effect on the second. Absolute stroke incidence therefore tracked the higher cumulative exposure to modifiable cardiometabolic conditions rather than any ethnicity-specific susceptibility once those conditions existed. This pattern aligns with earlier UK Biobank and US REGARDS findings that disparities largely collapse after adjustment for measured risk-factor burden, yet the present multistate design quantifies the exact pathway and rules out differential progression as a major driver.
Delord: Culturally adapted hypertension and diabetes screening programs in Lambeth will narrow the Black-white stroke incidence gap by at least 25% within five years, measurable in 2029 GP data.
Sources (3)
- [1]Primary Source(https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-12345-6)
- [2]Supporting Source(https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01456-3/fulltext)
- [3]Supporting Source(https://stroke.ahajournals.org/content/52/3/987)