Stroke, long seen as a declining threat in high-income countries, is making an unsettling comeback—and it is not affecting everyone equally. A major new analysis presented at the European Stroke Organisation Conference (ESOC) 2026 in Maastricht has found that stroke incidence is rising again after decades of progress, with the sharpest increases concentrated among ethnic minority and socioeconomically disadvantaged populations.

The findings, drawn from the South London Stroke Register (SLSR), paint a stark picture. Covering a diverse population of around 333,000 people and tracking cases over 30 years, the register documented 7,726 first-ever strokes. Between 1995–1999 and 2010–2014, stroke rates dropped by 34%, a public health success story. But that trend has now reversed. Between 2020 and 2024, stroke incidence rose by 13%—signifying what researchers describe as a worrying shift.

The burden, however, is uneven. Black African and Black Caribbean populations were found to have more than double the stroke incidence compared to White populations in recent years. These disparities are not new, but they are becoming more pronounced. Those living in poorer conditions faced the highest risks, pointing to a persistent and widening gap in health outcomes.

Lead researcher Dr Camila Pantoja-Ruiz of King’s College London linked part of this reversal to the aftershocks of the COVID-19 pandemic. “This trend may partly reflect the lasting impact of the COVID-19 pandemic, which reduced access to primary care, blood pressure monitoring and prescribing, particularly affecting Black and deprived communities,” she said.

Stroke occurs when blood supply to the brain is blocked or when a blood vessel bursts. Both situations deprive brain cells of oxygen, leading to lasting damage or death. One of the most dangerous forms, intracerebral haemorrhage—a type caused by bleeding inside the brain—showed the widest ethnic disparities in the study. This form is often linked to uncontrolled high blood pressure.

And that is where the problem begins to deepen. The study found that Black African and Black Caribbean populations had significantly higher rates of high blood pressure and diabetes—two major drivers of stroke. In simple terms, persistently high pressure in blood vessels can weaken them over time, making rupture or blockage more likely. Diabetes, meanwhile, damages blood vessels quietly over years.

Yet, a striking detail stood out. Around 12% of Black African patients had no diagnosed risk factors before their stroke, compared with just over 6% in White patients. This indicates that numerous cases are going undiagnosed, untreated, and unnoticed until it's too late.

“These patterns of increased stroke risk in these communities may also be influenced by broader factors, including racism, unconscious bias and socioeconomic circumstances, which can impact access to and quality of care,” Dr. Pantoja-Ruiz noted.

The inequalities do not end with diagnosis. The period after a stroke is critical. It is the window where doctors work to prevent a second, often more severe attack. But here too, gaps appear. Black stroke survivors—especially Black African patients—were significantly less likely to receive timely follow-up care. The odds were 34% lower compared to other groups.

“The period immediately after a stroke is critical for preventing another,” Dr Pantoja-Ruiz explained. Interventions such as controlling blood pressure, optimising medication, and identifying other cardiovascular risks are essential. Less timely follow-up leaves patients at elevated risk for longer.”

There are also signs that strokes are striking earlier. On average, Black African individuals experienced stroke 10 to 12 years sooner than their White counterparts. This earlier onset carries serious consequences—not just for individuals, but for families and economies.

What makes the SLSR findings particularly robust is the way the data was gathered. Unlike hospital-based studies, this national register captures every stroke case within a defined community, including those who never reach specialist care. Sustaining such a dataset over three decades has allowed researchers to see patterns that shorter studies often miss.

Globally, similar trends are emerging in other urban populations. Prevention programmes exist, but they are not reaching those most at risk. Screening, early diagnosis, and consistent follow-up remain unevenly distributed, particularly among marginalised communities who face barriers to accessing healthcare services.

The message from Maastricht is clear. Stroke is no longer just a medical issue—it is a mirror reflecting deeper social divides. Without targeted interventions, improved access to care, and trust-building within vulnerable communities, the gains of past decades may continue to unravel.