Objective: Examine the effect of race and gender variation on the burden of stroke and associated risk factors among hospital-discharged patients. Materials and Methods: We examined Tennessee Hospital Discharge Database from 1997 to 2008 for patients (older than 20 years) discharged with a diagnosis of stroke. The number of stroke patients was 17,149 in 1997; 19,020 in 2003; and 17,010 in 2008. We also extracted data on cardiovascular risk factors for each patient. Age-adjusted prevalence of hospitalization for stroke per 100K for non-Hispanic white and black patient groups was developed per Center of Disease Control (CDC) procedures of at-risk population. Race- and gender-specific prevalence of stroke and associated cardiovascular risk factors among hospitalized patients were examined using multivariate logistic models. To examine consistency, we compared the two groups at three different points: 1997, 2003, and 2008 regarding the prevalence of stroke and their associated risk factors. Results: Our analyses revealed three major trends: (1) Age-adjusted stroke rate declined by 13.8% over a 12-year period (from 466.8 per 100,000 in 1997 to 402.2 per 100,000 in 2008). This decline occurred for both black and white patients. However, the white stroke rate declined by 19.8% (from 401.9 in 1997 to 322.2 in 2008), compared with only 13.7% among blacks (from 599.2 in 1997 to 517.3 in 2008). Additionally, throughout the 12-year period, although no significant gender differences were observed, the stroke rates among blacks remained consistently higher compared with whites (black:white rate ratios of 1.60 in 1997, 1.40 in 2003, and 1.60 in 2008). Logistic regression analysis revealed the four risk factors that consistently predicted stroke for both black and white patients in 1997, 2003, and 2008, namely, hypertension (HTN), diabetes mellitus (DM), high cholesterol, and cardiac arrhythmia. Conclusion : Aggressive management of two cardiovascular risk factors (HTN and DM) may subsequently reduce stroke health disparity and the burden of stroke hospitalization among blacks.