The Risk of Stroke by Race

The risk of stroke shows great disparity across race in the United States. The discrepancy is not necessarily entirely genetic, as many people have a broad genetic diversity in their background. For this reason, defining race can be a challenge, since the U.S. census allows people to specify their own race and ethnicity. In 2000, there were 126 racial and ethnic categories reported. 

However, keeping in mind these limitations, studies are still performed using broader categories, which include African American/Black, non-Hispanic White, Hispanic, and American Indian/Alaska Native. Not all studies examine all these races, but certain trends have been found in all studies.

Strokes by race

The most glaring trend is a significantly higher rate of stroke among African Americans as compared to any other race measured, and the greatest disparity tends to occur in the younger cohorts of 35-44 years and 45-54 years. Sample studies below demonstrate these severe race discrepancies: 

Greater Cincinnati/Northern Kentucky first-time stroke study 1993:

  • At ages 35-44, the African American/non-Hispanic White stroke ratio was 3.78 (121 vs 32 strokes);
  • At ages 45-54, the stroke ratio was 5.08 (320 vs 63 strokes)

Northern Manhattan stroke study 1993-96 all strokes, comparing African American, Hispanic, and non-Hispanic White:

  • Ages 35-44 had 54, 53, and 6 strokes respectively – the ratio of African American to non-White was 9.0;
  • Ages 45-54 had 184, 127, and 49 strokes respectively – the stroke ratio of African American to non-White was 3.76; the ratio of African American to Hispanic was 2.59

Death rate by stroke per 100,000 population by age and gender for Black and white populations 2009:

  • Men age 45-54: Blacks 45.5 stroke deaths, whites 12.2 stroke deaths, ratio 3.7; women’s Black/white ratio similar at 3.5, with 34.8 and 9.9 deaths respectively
  • Men age 55-64: Blacks 106.9 deaths, whites 32.3 deaths, ratio 3.3; women’s Black/white ratio 2.7, with 66.7 and 24.7 stroke deaths respectively

 These are truly shocking numbers.

Misclassification can sometimes skew results, especially among Native Americans. This misclassification can vary from state to state; for instance, in Arizona, just 1.2% of Native Americans were misclassified as another race, while in California, 30.4% were misreported. This caused an underestimation of the rates of cardiovascular disease among Native Americans. Adjustment of the race distribution more clearly demonstrated a higher rate of cardiovascular disease, which correlated more accurately to the higher levels of risk factors in this community.

Possible reasons for the disparity

The rate of death and serious disability from stroke is greater among American minority groups than non-Hispanic whites. The reasons are still being studied, but they are many and complex. 

Health factors that increase stroke risk are well known, the most serious being hypertension (high blood pressure), elevated cholesterol, diabetes, obesity, tobacco use, excessive alcohol consumption, and heart disease. Stress, food choices, and a sedentary lifestyle contribute to these factors. 

Socioeconomic and regional factors also play into the disparity, as African Americans are often in lower income brackets, have poorer access to health care, and are less educated about health issues. Certain regions of the country have such higher stroke rates that they are referred to as the Stroke Belt and the Stroke Buckle. These include parts of North Carolina, Georgia, Tennessee, Mississippi, Alabama, Louisiana, and Arkansas. Regional foods in these areas may promote more health problems, leading to many of the stroke risk factors listed above. 

Other issues that create barriers to better health care and health education for minorities include language barriers and distrust or misunderstanding of the health care system. 

How to protect yourself and your loved ones

Everyone, regardless of race or gender, should take steps to protect themselves from stroke. Stroke is the number one cause of disability and the number three cause of death in the United States, but most risk factors are largely avoidable.

Though it can be difficult, making lifestyle changes can dramatically decrease your risk of disability or death from stroke. Visit a doctor with the specific intention to determine your stroke risk and learn some concrete steps to take to protect yourself. 

If you are at a high risk of stroke, consider using our stroke detection system, which looks like a smartwatch and is backed by state-of-the-art AI technology. Our wristband alerts medical professionals at the first sign of asymmetric arm movement, one of the most common early warnings of stroke onset. Ask your doctor about adding Neuralert’s wristbands to your stroke-prevention plan.

Making these changes can be particularly difficult if you live in a community whose culture and cuisine can increase health risks. Remember, you can honor your culture but still make healthy lifestyle changes. Talk to friends and family and educate them about stroke factors. Ask them to make lifestyle changes with you, and together you can brainstorm healthier new traditions to celebrate your unique history.