{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T14:30:58Z","timestamp":1786113058787,"version":"build-2736575974"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Ethnic disparities in stroke incidence and recurrence are well-known but there is conflicting evidence regarding post-stroke care and recovery. In the UK, stroke-survivors are recommended a six-month specialist review but fewer than half receive this review, potentially exacerbating health inequities. Using data from the Sentinel Stroke National Audit Programme (SSNAP) from inception to August 2023 across four regions in England with varying ethnicity profiles we conducted a retrospective descriptive analysis to assess ethnic differences in six-month care and outcomes for stroke-survivors. A total of 80,413 (26.2%) stroke-survivors attended their 6-month review (whites: 26.5%, Black patients: 27.9%; Asian patients: 26.1%; Mixed patient: 27.6%; other: 23.5% other; unknown: 23.1%) with a higher proportion of reviews taking place via telephone for Black and Asian patients (X\u2009=\u2009955.7, p\u2009=\u20090.001). After adjustment, non-White patients were significantly more likely to be followed up at 6 months (Black patients OR 1.29 (95%CI 1.21\u20131.38), Asian patients OR 1.10 (95% CI: 1.04\u20131.15). The odds of having a further stroke (Black OR 1.49 (95% CI: 1.21\u20131.84), Asian OR 1.25 (95% CI 1.03\u20131.52)) or other illness requiring hospital readmission (Black OR 1.25 (95% CI: 1.12\u20131.40), Asian OR 1.15 (1.05\u20131.27)) were significantly higher in Black and Asian patients following adjustment for age and stroke severity. At six months lipid therapy was significantly lower in Black patients (OR 0.79 (95% CI: 0.72\u20130.87)). Black and Asian stroke-survivors experience worse outcomes and lower use of secondary prevention despite similar clinic attendance. Culturally sensitive interventions are needed to reduce post-stroke complications.<\/jats:p>","DOI":"10.1371\/journal.pone.0354353","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T17:26:47Z","timestamp":1785950807000},"page":"e0354353","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ethnic disparities in the longer-term clinical care and outcomes of stroke patients in England"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1030-9311","authenticated-orcid":true,"given":"Eugene Yee Hing","family":"Tang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0530-3564","authenticated-orcid":true,"given":"Uchenna","family":"Anyanwagu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Price","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"The SSNAP Collaboration","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"issue":"5","key":"pone.0354353.ref001","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1161\/STROKEAHA.122.040073","article-title":"Projected global trends in ischemic stroke incidence, deaths and disability-adjusted life years from 2020 to 2030","volume":"54","author":"L Pu","year":"2023","journal-title":"Stroke"},{"issue":"10","key":"pone.0354353.ref002","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"20","author":"GBD 2019 Stroke Collaborators","year":"2021","journal-title":"Lancet Neurol"},{"issue":"7","key":"pone.0354353.ref003","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1161\/STROKEAHA.115.012631","article-title":"Where to focus efforts to reduce the black\u2013white disparity in stroke mortality","volume":"47","author":"G Howard","year":"2016","journal-title":"Stroke"},{"issue":"4","key":"pone.0354353.ref004","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1161\/STROKEAHA.119.028806","article-title":"Race and ethnic disparities in stroke incidence in the northern manhattan study","volume":"51","author":"H Gardener","year":"2020","journal-title":"Stroke"},{"issue":"22","key":"pone.0354353.ref005","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000201225","article-title":"Racial disparities in stroke recurrence: A population-based study","volume":"99","author":"DJ Robinson","year":"2022","journal-title":"Neurology"},{"issue":"3","key":"pone.0354353.ref006","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1161\/STROKEAHA.121.036263","article-title":"Evidence-based disparities in stroke care metrics and outcomes in the United States: A systematic review","volume":"53","author":"S Ikeme","year":"2022","journal-title":"Stroke"},{"issue":"7","key":"pone.0354353.ref007","doi-asserted-by":"crossref","DOI":"10.1161\/STR.0000000000000437","article-title":"Strategies to reduce racial and ethnic inequities in stroke preparedness, care, recovery, and risk factor control: A scientific statement from the American Heart Association","volume":"54","author":"A Towfighi","year":"2023","journal-title":"Stroke"},{"key":"pone.0354353.ref008","author":"Intercollegiate Stroke Working Party","year":"2023"},{"key":"pone.0354353.ref009","year":"2024"},{"issue":"8","key":"pone.0354353.ref010","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1017\/S1355617717000480","article-title":"Racial differences in neurocognitive outcomes post-stroke: The impact of healthcare variables","volume":"23","author":"NX Johnson","year":"2017","journal-title":"J Int Neuropsychol Soc"},{"issue":"1","key":"pone.0354353.ref011","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.dhjo.2018.08.005","article-title":"Racial and ethnic differences in post-stroke subjective cognitive decline exist","volume":"12","author":"SP Burns","year":"2019","journal-title":"Disabil Health J"},{"key":"pone.0354353.ref012","author":"Office for National Statistics","year":"2021"},{"key":"pone.0354353.ref013"},{"issue":"6","key":"pone.0354353.ref014","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1007\/s10072-023-06640-z","article-title":"Adverse stroke outcomes amongst UK ethnic minorities: A multi-centre registry-based cohort study of acute stroke","volume":"44","author":"D Fluck","year":"2023","journal-title":"Neurol Sci"},{"issue":"19","key":"pone.0354353.ref015","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000006467","article-title":"Racial differences in recurrent ischemic stroke risk and recurrent stroke case fatality","volume":"91","author":"KC Albright","year":"2018","journal-title":"Neurology"},{"issue":"5","key":"pone.0354353.ref016","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1161\/STROKEAHA.119.027791","article-title":"Association Between immigration status and acute stroke care: A retrospective study","volume":"51","author":"MV Vyas","year":"2020","journal-title":"Stroke"},{"issue":"7","key":"pone.0354353.ref017","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1007\/s11606-018-4471-1","article-title":"Racial and Ethnic Disparities in Diagnosis of Chronic Medical Conditions in the USA","volume":"33","author":"EJ Kim","year":"2018","journal-title":"J Gen Intern Med"},{"issue":"3","key":"pone.0354353.ref018","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.cct.2010.02.003","article-title":"A stroke preparedness RCT in a multi-ethnic cohort: Design and methods","volume":"31","author":"B Boden-Albala","year":"2010","journal-title":"Contemp Clin Trials"},{"issue":"7","key":"pone.0354353.ref019","doi-asserted-by":"crossref","first-page":"1806","DOI":"10.1161\/STROKEAHA.114.008502","article-title":"Comparison of acute stroke preparedness strategies to decrease emergency department arrival time in a multiethnic cohort: The stroke warning information and faster treatment study","volume":"46","author":"B Boden-Albala","year":"2015","journal-title":"Stroke"},{"issue":"1","key":"pone.0354353.ref020","article-title":"Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada","volume":"103","author":"MV Vyas","year":"2024","journal-title":"Neurology"},{"issue":"11","key":"pone.0354353.ref021","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/S1474-4422(09)70236-4","article-title":"Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: A systematic review and meta-analysis","volume":"8","author":"ST Pendlebury","year":"2009","journal-title":"Lancet Neurol"},{"issue":"3","key":"pone.0354353.ref022","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/S1474-4422(18)30442-3","article-title":"Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: Analysis of the population-based Oxford Vascular Study","volume":"18","author":"Oxford Vascular Study","year":"2019","journal-title":"Lancet Neurol"},{"issue":"1","key":"pone.0354353.ref023","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCOUTCOMES.116.003228","article-title":"Efficacy of a chronic care-based intervention on secondary stroke prevention among vulnerable stroke survivors: A randomized controlled trial","volume":"11","author":"EM Cheng","year":"2018","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"4","key":"pone.0354353.ref024","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1046\/j.1532-5415.2002.50165.x","article-title":"Cognitive impairment after stroke: Clinical determinants and its associations with long-term stroke outcomes","volume":"50","author":"MD Patel","year":"2002","journal-title":"J Am Geriatr Soc"},{"issue":"5","key":"pone.0354353.ref025","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/S1474-4422(14)70016-X","article-title":"Neuropsychiatric outcomes of stroke","volume":"13","author":"ML Hackett","year":"2014","journal-title":"Lancet Neurol"},{"issue":"3","key":"pone.0354353.ref026","article-title":"Prevalence and natural history of depression after stroke: A systematic review and meta-analysis of observational studies","volume":"20","author":"L Liu","year":"2023","journal-title":"PLoS Med"},{"issue":"3","key":"pone.0354353.ref027","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1177\/1747493019896958","article-title":"Frequency of anxiety after stroke: An updated systematic review and meta-analysis of observational studies","volume":"15","author":"P Knapp","year":"2020","journal-title":"Int J Stroke"},{"issue":"8","key":"pone.0354353.ref028","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1111\/ijs.12356","article-title":"Part II: Predictors of depression after stroke and impact of depression on stroke outcome: An updated systematic review of observational studies","volume":"9","author":"MA Kutlubaev","year":"2014","journal-title":"Int J Stroke"},{"issue":"7","key":"pone.0354353.ref029","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1161\/STROKEAHA.110.605808","article-title":"Natural history, predictors, and associations of depression 5 years after stroke: The South London Stroke Register","volume":"42","author":"L Ayerbe","year":"2011","journal-title":"Stroke"},{"issue":"18","key":"pone.0354353.ref030","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1212\/WNL.0b013e3181fb44b3","article-title":"Auckland Stroke Outcomes Study. Part 1: Gender, stroke types, ethnicity, and functional outcomes 5 years poststroke","volume":"75","author":"VL Feigin","year":"2010","journal-title":"Neurology"},{"key":"pone.0354353.ref031"},{"key":"pone.0354353.ref032","year":"2024"},{"key":"pone.0354353.ref033","article-title":"Multiple imputation for missing data in epidemiological and clinical research: Potential and pitfalls","volume":"338","author":"JAC Sterne","year":"2009","journal-title":"BMJ"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354353","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T17:26:52Z","timestamp":1785950812000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354353"}},"subtitle":[],"editor":[{"given":"Antony","family":"Bayer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":33,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0354353","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]}}}