<jats:p> <jats:bold> <jats:italic>Background and Purpose—</jats:italic> </jats:bold> Data monitoring trends in stroke risk among different ethnic groups are lacking. Thus, we investigated trends in stroke incidence and modifiable stroke risk factors over a 10-year time period between different ethnic groups. </jats:p> <jats:p> <jats:bold> <jats:italic>Methods—</jats:italic> </jats:bold> Changes in stroke incidence were investigated with the South London Stroke Register (SLSR). The SLSR is a population-based stroke register, covering a multiethnic population of 271 817 inhabitants in South London with 63% white, 28% black, and 9% of other ethnic group (2001 Census). </jats:p> <jats:p> <jats:bold> <jats:italic>Results—</jats:italic> </jats:bold> Between 1995 and 2004, 2874 patients with first-ever stroke of all age groups were included. Total stroke incidence decreased over the 10-year study period in men (incidence rate ratio 1995 to 1996 versus 2003 to 2004 [IRR] 0.82, 95% CI 0.69 to 0.97) and in women (IRR 0.76, 95% CI 0.64 to 0.90). A similar decline in total stroke incidence could be observed in whites for men and women (IRR 0.76, 95% CI 0.62 to 0.93 versus IRR 0.73, 95% CI 0.59 to 0.89, respectively); in blacks, total stroke incidence was reducing only in women (IRR 0.48, 95% CI 0.31 to 0.75). In whites, the prevalence of prior-to-stroke hypertension ( <jats:italic>P</jats:italic> =0.0017), atrial fibrillation ( <jats:italic>P</jats:italic> =0.0113), and smoking ( <jats:italic>P</jats:italic> =0.0177) decreased; no statistically significant changes in prior-to-stroke risk factors were observed in blacks. Total stroke incidence was higher in blacks compared to whites (IRR 1.27, 95% CI 1.10 to 1.46 in men; IRR 1.29, 95% CI 1.11 to 1.50 in women), but the black-white gap reduced during the 10-year time period (IRR 1.43, 95% CI 1.13 to 1.82 in 1995 to 1996 to 1.18, 95% CI 0.93 to 1.49 in 2003 to 2004). </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusions—</jats:italic> </jats:bold> Stroke incidence decreased over a 10-year time period. The greatest decline in incidence was observed in black women, but ethnic group disparities still exist, indicating a higher stroke risk in black people compared to white people. Advances in risk factor reduction observed in the white population were failed transferring to the black population. </jats:p>