Does Ethnicity Alter the Hazard of Stroke in Patients withMajor Modifiable Cardiometabolic Risk Factors? A population-based Longitudinal Studyusing Electronic Health Records in South London

Does Ethnicity Alter the Hazard of Stroke in Patients withMajor Modifiable Cardiometabolic Risk Factors? 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A population-based Longitudinal Studyusing Electronic Health Records in South London Marc Delord, Abdel Douiri This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8949415/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: Ethnic inequality in stroke risk was partially explained by a history of hypertension, diabetes and socioeconomic status. We aimed to estimate the impact of ethnicity on the hazard of stroke in patients with hypertension, diabetes or hypercholesterolaemia in an urban, multiethnic, youthful and deprived population. Methods: Multistate models were constructed using electronic health records, including the date of stroke onset, stroke risk factors, and the Index of Multiple Deprivation in Asian, Black or White adult patients registered at 41 general practices in South London between 2005 and 2021. Transitions to hypertension, diabetes or hypercholesterolaemia (transition 1), and from these cardiometabolic risk factors to stroke (transition 2) were considered. Results: The study included 651,888 of the 849,968 registered patients (76.7%), of whom 8.6% were Asian, 18.2% Black, and 73.2% White, while 54.1% were female. Among Black patients, 2.1% had a recorded stroke, compared with 1.2% of Asian patients and 1.0% of White patients. Compared to White patients, Asian and Black patients had generally a higher risk of transitioning to hypertension, diabetes or hypercholesterolaemia (transition 1). Ethnicity however, did not affect transition to stroke from cardiometabolic risk factors (transition 2), except for hypercholesterolaemia, where Black patients had a higher risk of strokes. Conclusion: Our results confirm that Black ethnicity does not confer excess hazard of stroke in patients with hypertension or diabetes. This observation was also made for Asian ethnicity. An excess hazard of stroke associated with Black ethnicity was observed only in patients with hypercholesterolaemia. Ethnic disparity Stroke Cardiometabolic risk factors hypercholesterolaemia Multistate Model Electronic Health Records Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 20 Apr, 2026 Reviewers agreed at journal 07 Apr, 2026 Reviews received at journal 31 Mar, 2026 Reviewers agreed at journal 24 Mar, 2026 Reviewers invited by journal 19 Mar, 2026 Submission checks completed at journal 25 Feb, 2026 First submitted to journal 25 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8949415","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":609027901,"identity":"c7e107f9-4b8c-46e7-829a-3d008b1770ba","order_by":0,"name":"Marc Delord","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYNACNgYZIGn4sIHBAsxnbCBCCw+QNDZsYJAgTYuZJFFadNvPPvzAUGbDwy99eFvljBoJBv72A2ySM/BoMTuTbizBcC6NR7IvrezmhmMSDBJnEtgkN+DTciCNjYGx7TCPwRkes5sPG4AOu8HAJvkAn5bzz0Ba/oO1FIK0yBPUcgNsywGwFsaNQC0GIC14HXbjGbNEwrlkHsketmLJGcckeAzPJDZb4vX++TTGDx/K7OT4eZg3fuypsZGTO3744M0ePFrAIAGJzUNURI6CUTAKRsEowA8ASqVEyx4cxUgAAAAASUVORK5CYII=","orcid":"","institution":"King's College London","correspondingAuthor":true,"prefix":"","firstName":"Marc","middleName":"","lastName":"Delord","suffix":""},{"id":609027902,"identity":"b283b8e1-a020-4c1f-8c2e-2ccd9a571edf","order_by":1,"name":"Abdel Douiri","email":"","orcid":"","institution":"King's College London","correspondingAuthor":false,"prefix":"","firstName":"Abdel","middleName":"","lastName":"Douiri","suffix":""}],"badges":[],"createdAt":"2026-02-23 17:09:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8949415/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8949415/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105255239,"identity":"0cb37dad-237c-4f60-a757-9f3c93107d2a","added_by":"auto","created_at":"2026-03-24 04:25:20","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1077414,"visible":true,"origin":"","legend":"","description":"","filename":"ETHCMRF2.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8949415/v1_covered_802e4a3c-73e8-4ab0-a58f-310cb056f47e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Does Ethnicity Alter the Hazard of Stroke in Patients withMajor Modifiable Cardiometabolic Risk Factors? A population-based Longitudinal Studyusing Electronic Health Records in South London","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Ethnic disparity, Stroke, Cardiometabolic risk factors, hypercholesterolaemia, Multistate Model, Electronic Health Records","lastPublishedDoi":"10.21203/rs.3.rs-8949415/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8949415/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Background: Ethnic inequality in stroke risk was partially explained by a history of hypertension, diabetes and socioeconomic status. We aimed to estimate the impact of ethnicity on the hazard of stroke in patients with hypertension, diabetes or hypercholesterolaemia in an urban, multiethnic, youthful and deprived population.\n\nMethods: Multistate models were constructed using electronic health records, including the date of stroke onset, stroke risk factors, and the Index of Multiple Deprivation in Asian, Black or White adult patients registered at 41 general practices in South London between 2005 and 2021. Transitions to hypertension, diabetes or hypercholesterolaemia (transition 1), and from these cardiometabolic risk factors to stroke (transition 2) were considered.\n\nResults: The study included 651,888 of the 849,968 registered patients (76.7%), of whom 8.6% were Asian, 18.2% Black, and 73.2% White, while 54.1% were female. Among Black patients, 2.1% had a recorded stroke, compared with 1.2% of Asian patients and 1.0% of White patients. Compared to White patients, Asian and Black patients had generally a higher risk of transitioning to hypertension, diabetes or hypercholesterolaemia (transition 1). Ethnicity however, did not affect transition to stroke from cardiometabolic risk factors (transition 2), except for hypercholesterolaemia, where Black patients had a higher risk of strokes.\n\nConclusion: Our results confirm that Black ethnicity does not confer excess hazard of stroke in patients with hypertension or diabetes. This observation was also made for Asian ethnicity. An excess hazard of stroke associated with Black ethnicity was observed only in patients with hypercholesterolaemia.","manuscriptTitle":"Does Ethnicity Alter the Hazard of Stroke in Patients withMajor Modifiable Cardiometabolic Risk Factors? 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