Native Hawaiian and Pacific Islander people face highest stroke rates in the U.S.

A new study found that Native Hawaiian or Pacific Islander people had the highest rate of stroke among people from other race and ethnic groups, with a rate more than three times higher than that of white people. The study is published on August 27, 2025, in Neurology^®, the medical journal of the American Academy of Neurology.

Multiple studies have shown racial and ethnic disparities in the rate of stroke in the United States, but there is little information on the rate among Native Hawaiian or Pacific Islander people, especially among those living in the contiguous US mainland. Since Native Hawaiian or Pacific Islander people are among the fastest growing populations in the US and have one of the highest rates of death from cardiovascular disease, we wanted to focus on the risk among this group."

Fadar O. Otite, MD, MS, study author of the State University of New York Upstate Medical University in Syracuse and member of the American Academy of Neurology

Researchers examined databases from Florida, Georgia, Maryland and New York for cases of ischemic stroke during a period of up to six years. Ischemic stroke, the most common type of stroke, is when blood flow is blocked to part of the brain.

The stroke cases were combined with Census data from each state on the number of white, Black, Hispanic, Asian, and Native Hawaiian or Pacific Islander people to determine the rate of stroke.

There were 799,150 cases of stroke during the study. After adjusting for age and sex, researchers found the stroke rate for Native Hawaiian or Pacific Islander people was 591 cases for 100,000 people, compared to 292 cases for Black people, 180 cases for white people, 145 cases for Hispanic people and 108 cases for Asian people.

After researchers adjusted further for year of hospitalization to account for advances in stroke care, they found that the stroke rate was 3.3 times higher among Native Hawaiian or Pacific Islander people than among white people, almost four times higher than among Hispanic people and more than five times higher than among Asian people. Native Hawaiian or Pacific Islander people had a lower rate of stroke than Black people in Florida, but a higher rate in Georgia, Maryland and New York.

"More research is needed into the reasons for this disparity so that it can be tackled appropriately," Otite said. "These findings also lend support to the need for parsing out information on race and ethnicity in health care databases, where Asian people and Native Hawaiian or Pacific Islander people are usually combined into one large group."

A limitation of the study was that only strokes where the person was taken to the hospital were captured, so the total number of cases would be higher if people who never went to the hospital were included.