ABSTRACT NUMBER: ESOC2026A1890 ETHNIC AND SOCIOECONOMIC INEQUALITIES IN PRE-STROKE VASCULAR RISK FACTOR PROFILES: THE SOUTH LONDON STROKE REGISTER 1995-2024

Abstract Background and aims Stroke disproportionately affects ethnic minority and lower socioeconomic groups. We investigated ethnic and socioeconomic inequalities and trends in pre-stroke vascular risk factor (VRF) profiles. Methods Population-based cohort study of adults with stroke (N=8,515), stratified by ethnicity, occupation, and education. Associations between ethnicity, socioeconomic status and pre-stroke VRFs were calculated using Poisson regression. Results Mean age at stroke was 59.6 years in Black Africans, 68.1 in Black Caribbeans, and 71.8 in White participants. 12.0% of Black Africans had no pre-stroke risk factor diagnosis (White participants: 6.3%). Black (vs White) participants and those with lower (vs higher) occupation or education had higher rates of hypertension (adjusted prevalence ratio: Black Caribbean 1.29 [95%CI:1.24-1.34], Black African 1.47 [1.40-1.53], manual/routine occupation 1.09 [1.05-1.13], lower education 1.06 [1.02-1.11]), and diabetes (Black Caribbean 2.23 [2.04-2.43], Black African 1.92 [1.73-2.13], manual/routine 1.23 [1.13-1.34], lower education 1.21 [1.09-1.37]), but lower rates of atrial fibrillation (Black Caribbean 0.57 [0.48-0.68], Black African 0.66 [0.54-0.82], lower education 0.78 [0.68-0.91]). Ethnic and socioeconomic inequalities in diabetes and hypertension widened over time but narrowed for atrial fibrillation. 36% of strokes occurred in people with at least one diagnosed, but untreated risk factor throughout the study period. Conclusions Hypertension- and diabetes-related strokes are more frequent and rising faster in ethnic minority and lower socioeconomic groups, driving incidence inequalities. Black people’s younger stroke age and higher proportion without pre-stroke VRF diagnosis warrant targeted and earlier primary prevention efforts to tackle health inequalities. Conflict of interest Eva Emmett: nothing to disclose; Camila Pantoja_Ruiz: nothing to disclose; Amal Khanolkar: nothing to disclose; Charles Wolfe: nothing to disclose; Matthew O'Connell: nothing to disclose; Iain Marshall: nothing to disclose