Black people in the United States are often at higher risk for stroke than other racial groups, largely because they’re at higher risk for underlying conditions that can lead to stroke. But genetics and social factors also play a role.

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A stroke is a loss of blood to a part of your brain. Blood carries oxygen to your brain. When your brain cells don’t get enough oxygen, they can die. Without prompt treatment, stroke can cause disability, brain damage, or death.

According to the Office of Minority Health, if you’re a Black man in the United States, your risk for stroke is 50% higher than for a white man. You’re also 70% more likely to die from it. If you’re a Black woman, you are twice as likely to have a stroke as a white woman and 30% more likely to die.

In 2015, Black people had the highest mortality rate from stroke of any racial group and were more likely to be disabled afterward. Black people are more at risk because of a higher risk for high blood pressure, diabetes, and obesity, all of which contribute to stroke. But that’s just a small part of the story.

Read on to learn more about why African Americans have a greater stroke risk and what you can do to lower your risk.

Many factors come together to determine your stroke risk. While some are beyond your control, others may be within your control.

Controllable risk factorsUncontrollable risk factors
• High blood pressure
• Obesity
• Diabetes
• Untreated sleep disorders
• High cholesterol
Carotid artery disease
Peripheral artery disease
Atrial fibrillation
• Other heart diseases
• Sickle cell anemia

• Smoking
• Diet
• Exercise
• Sleep
• Illegal drug use
• Genetics
• Age
• Gender
• Race or ethnicity
• Weather or climate
• Previous stroke
• Previous heart attack
• Previous transient ischemic attack (TIA)
• Social determinants of health

But even among controllable risk factors, you may find it difficult to make changes. For example, your ability to manage an underlying condition may depend on your access to quality healthcare. Dietary changes may be challenging if you live in an area with limited food choices.

A lot of that has to do with social determinants of health (SDOHs) — nonmedical factors that can influence your health outcomes. But more on that later.

Let’s take a detailed look at how some of these risk factors especially affect the Black community.

Black people have a higher risk for conditions that contribute to stroke. More than two-thirds have at least one risk factor for stroke, including the following underlying conditions:

High blood pressure

High blood pressure, also called hypertension, is when your heart pumps blood through your body with too much force. There are many causes, and more than half of Black U.S. adults have it.

If your blood pressure is 120/80 mmHg or higher, you may have hypertension or be at risk.

Note that high blood pressure often does not have any symptoms.


According to the American Stroke Association, nearly 70% of Black men and more than 80% of Black women in the United States are overweight or have obesity. Carrying too much weight puts you at risk of a long list of chronic conditions and can worsen many you may have, such as hypertension.

Healthcare professionals generally consider you overweight if you have a body mass index (BMI), or height-to-weight ratio, over 25. To have obesity, you’d have a BMI over 30.

That said, many criticize BMI as a measure because it doesn’t take into account muscle mass or body fat distribution.

High cholesterol

Hypercholesterolemia, or high cholesterol, is a condition in which you have too much LDL cholesterol in your blood. Your liver makes cholesterol, a waxy, fat-like substance. You also get it from the food you eat.

There are two kinds, HDL and LDL. The second type can put your health at risk. Almost 30% of Black people have too much of it.

Sickle cell anemia

Sickle cell anemia (SCA) is a genetic disease in which your red blood cells are crescent-shaped instead of round. The cells can get stuck in small blood vessels, causing blockages, including in your brain. The blockages can lead to a stroke.

SCA is much more prevalent among African Americans than other racial groups. According to the Centers for Disease Control and Prevention (CDC), 1 in 365 Black people in the United States is born with SCA. The gene for the sickle cell trait is present in 1 in every 13 Black babies.

A 2018 analysis found that having the trait, without the condition, doesn’t increase your risk, but having SCA does.

African Americans are a diverse group of people with varied interests and lifestyle habits. Still, there are a few experiences more common among African Americans that may contribute to stroke risk.


According to the American Lung Association, African American men smoke more than men from any other racial group. Black people who smoke have more than double the risk of stroke compared to nonsmokers.

Salt intake

Too much salt can raise your blood pressure and increase your stroke risk. According to the CDC, about 85% of Black U.S. adults consume too much salt.

There was a theory regarding genetic factors in Black people that make them more sensitive to the harmful effects of too much salt. But that theory was rooted in assumptions about slavery, and there isn’t much data to back it up. New research suggests that it may be due to not consuming enough potassium. But more research is needed.


Some research suggests that stress may be a significant cause of high blood pressure in African Americans. This can, in turn, increase your risk of stroke.

Also, some of this stress can be attributed to experiencing daily and institutional racism.

Your address matters when it comes to stroke risk. In a 2022 study, Black people who lived in the South — in the so-called “Stroke Belt” — had higher stroke mortality rates than whites. The Stroke Belt comprises:

  • Alabama
  • Arkansas
  • Georgia
  • Indiana
  • Kentucky
  • Louisiana
  • Mississippi
  • North Carolina
  • South Carolina
  • Tennessee
  • Virginia

People who live in rural areas are also more likely to have strokes. Your risk also increases if you live in an area with:

  • poor healthcare options
  • limited transportation to healthcare professionals
  • fewer healthy food options
  • fewer green spaces for exercise

Lifestyle and environmental factors only account for 50% of stroke risk, according to a 2021 literature review. Genetic differences between people of African and European ancestry may contribute to the other half. But much more research is needed to understand better the role of genes in stroke in the Black population.

Studies have also examined whether people of African descent might have genes that make them more susceptible to diabetes and hypertension, risk factors for stroke.

SDOHs are nonmedical factors that can affect your health. They include:

  • economic and job stability
  • stable housing
  • pollution
  • neighborhood safety
  • access to transportation
  • systemic racism

These factors can profoundly influence your ability to manage underlying conditions and control your risk factors for stroke.

One significant SDOH is access to quality healthcare. Many Black Americans have less access and poorer health outcomes for that reason alone.

In addition to race and geography, a 2020 study identified other SDOHs linked to stroke risk, namely:

  • education
  • income
  • neighborhood poverty
  • health insurance
  • social isolation

The study also found that the more SDOHs affected you, the higher your stroke risk.

You can do many things to lower your risk of stroke. The American Stroke Association recommends the following:

  • Eat more fruits and vegetables.
  • Reduce salt in your diet.
  • Exercise more if you can.
  • If you smoke, quit.
  • Manage stress.
  • Maintain a moderate weight.
  • Treat any underlying conditions.
  • Talk with a healthcare professional about your unique risk factors and how to manage them.

Know the warning signs of a stroke

The F.A.S.T. acronym can help you spot stroke symptoms and respond quickly.

  • Face drooping
  • Arm weakness
  • Speech difficulty
  • Time to call 911

Other symptoms include:

  • headache with no known origin
  • confusion
  • vision problems in one or both eyes
  • trouble walking because of dizziness, loss of balance, or coordination
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