Stroke Risk Isn’t the Same for Every Black Patient, Study Finds

Individuals who identify as Black who are immigrants to the United States have reduced odds of stroke, with the lowest odds seen for those who have immigrated recently, according to a study published online July 15 in Neurology.

Alejandro Vargas, M.D., from the Rush University Medical Center in Chicago, and colleagues examined stroke prevalence among 64,717 individuals who identified as Black in the 2000 to 2018 National Health Interview Survey. Respondents were stratified according to age (25 to 55 or 56 to 74 years) and by birth location (United States; Caribbean, South, and Central America [CSCA]; and Africa).

Overall, 88.3, 8.0, and 3.7 percent of the respondents who identified as Black were born in the United States, CSCA, and Africa, respectively. The researchers found that stroke prevalence was 4.3, 1.5, and 0.8 percent, respectively. The odds of stroke were lower for foreign-born individuals (adjusted odds ratios, 0.44 and 0.39 for CSCA and Africa, respectively). The lowest odds of stroke were seen for those who had immigrated recently at the time of the survey (adjusted odds ratio, 0.27 for <15 years).

“Our study suggests a healthy immigrant effect in which recent immigrants are healthier than the general population,” Vargas said in a statement. “This may be due to differences in stroke risk factors such as high blood pressure or stress. Grouping all racial and ethnic populations together can hide important health trends and hinder efforts to create targeted interventions.”

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Race Alone Doesn’t Tell the Whole Story

Clinicians often discuss disparities between Black and white patients, but there is tremendous diversity within Black populations. African-born, Caribbean-born, and U.S.-born Black patients may have different health experiences, cultural practices, cardiovascular risk profiles, and environmental exposures. The study reinforces the importance of moving beyond broad racial categories when assessing stroke risk.

Rather than replacing existing risk models, the findings suggest that clinicians should consider birthplace and immigration history as additional components of a patient’s overall cardiovascular risk profile.

Why Might Immigrants Have Lower Stroke Risk?

One possible explanation is the Healthy Immigrant Effect (HIE), a phenomenon in which immigrants arrive in the United States with better overall health than the U.S.-born population, despite often facing socioeconomic disadvantages. Researchers have observed this pattern across multiple health outcomes, although the reasons behind it are complex and likely vary by population

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Several factors may contribute to the lower stroke risk observed among Black immigrants, including:

• Lower prevalence of hypertension or obesity before immigration
• Healthier dietary patterns
• Lower smoking rates in some populations
• Selection bias (healthier people are more likely to immigrate)
• Risk increasing over time as immigrants adopt U.S. lifestyles
• Chronic stress and structural barriers that accumulate with longer residence in the U.S.

Because this was an observational study, the researchers could not determine which of these factors, or combination of factors, accounts for the differences in stroke risk. Additional research is needed to better understand how immigration history influences cardiovascular health among diverse Black populations.

What This Means for Clinical Practice

While the study’s findings suggest that stroke risk may differ between U.S.-born and immigrant Black adults, they should not change how clinicians approach evidence-based stroke prevention. Instead, the study underscores the importance of individualized risk assessment that accounts for both traditional cardiovascular risk factors and a patient’s lived experiences.

Clinical Takeaways for Providers

• Avoid assuming all Black patients share identical stroke risk factors.
• Include country of birth and immigration history in the social history when clinically relevant.
• Continue aggressive screening for hypertension, diabetes, hyperlipidemia, and smoking regardless of birthplace.
• Tailor prevention counseling to the patient’s cultural background, dietary practices, and access to care.
• Recognize that stroke risk may change over time as patients spend more years living in the U.S.

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