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We conducted a PROSPERO\u2010registered systematic review and meta\u2010analysis (CRD42024518105) including over two million community\u2010dwelling adults. A two\u2010tier ethnicity framework was applied. Tier 1 used broad US Office of Management and Budget\u2010aligned categories to maximize comparability, showing that Asians with higher cerebral microbleeds, Whites with greater metabolic risks, Blacks with higher hypertension, and Hispanics with elevated diabetes. Tier 2 enabled finer intra\u2010Asian subgrouping, revealing Chinese cohorts with greater white matter hyperintensity (WMH) and hemorrhagic burden, Japanese with a lacunar\u2010predominant profile but lower microbleeds, and Koreans with blood pressure\u2013linked WMH. Ethnicity also moderated key risk\u2013lesion associations, including stronger effects of diabetes on WMH and lacunes in Chinese and of systolic blood pressure on WMHs in Koreans. These findings highlight that CSVD phenotypes differ across populations, reflecting complex interactions between vascular, genetic, and environmental factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>First meta\u2010analysis of CSVD markers stratified by global ethnic groups.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Tier 1: Asians had higher CMBs and lacunes; Whites had higher metabolic risk.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Tier 2: Chinese showed higher WMHs and CMBs; Japanese had more lacunes, fewer CMBs.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Risk\u2013CSVD associations varied by ethnicity, including diabetes and blood pressure.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Results suggest need for ethnicity\u2010informed prevention and harmonised reporting.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.70976","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T12:00:11Z","timestamp":1770638411000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Global ethnic disparities in cerebral small vessel disease imaging markers and vascular risk factors: a systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"22","author":[{"given":"Nikita K.","family":"Husein","sequence":"first","affiliation":[{"name":"Centre for Healthy Brain Ageing (CHeBA) Discipline of Psychiatry and Mental Health, School of Clinical Medicine University of New South Wales Kensington New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keshuo","family":"Lin","sequence":"additional","affiliation":[{"name":"Centre for Healthy Brain Ageing (CHeBA) Discipline of Psychiatry and Mental Health, School of Clinical Medicine University of New South Wales Kensington New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David K. E.","family":"Chan","sequence":"additional","affiliation":[{"name":"Stats Central, Statistical Consulting Unit, School of Mathematics and Statistics University of New South Wales  Kensington New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiyang","family":"Jiang","sequence":"additional","affiliation":[{"name":"Research Imaging NSW UNSW Sydney  Kensington New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Crawford","sequence":"additional","affiliation":[{"name":"Centre for Healthy Brain Ageing (CHeBA) Discipline of Psychiatry and Mental Health, School of Clinical Medicine University of New South Wales Kensington New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Perminder S.","family":"Sachdev","sequence":"additional","affiliation":[{"name":"Centre for Healthy Brain Ageing (CHeBA) Discipline of Psychiatry and Mental Health, School of Clinical Medicine University of New South Wales Kensington New South Wales Australia"},{"name":"Neuropsychiatric Institute Prince of Wales Hospital  Randwick New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wen","sequence":"additional","affiliation":[{"name":"Centre for Healthy Brain Ageing (CHeBA) Discipline of Psychiatry and Mental Health, School of Clinical Medicine University of New South Wales Kensington New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000007654"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpheart.00307.2018"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474\u20104422(19)30079\u20101"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/svn\u20102020\u2010000661"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474\u20104422(23)00131\u2010X"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000028229"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.5853\/jos.2017.02110"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.566992"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.054378"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0275309"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0b013e3182299496"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31829bfde3"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12508"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.149.2.351"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2020.01.008"},{"key":"e_1_2_11_17_1","volume-title":"Covidence Systematic Review Software","author":"Veritas Health Innovation"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.2104"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v036.i03"},{"key":"e_1_2_11_20_1","unstructured":"LenthRV.Emmeans: Estimated Marginal Means. 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