Background: International research has reported inequitable access to best practice stroke care by ethnicity, although the impact on outcomes remains unclear. In New Zealand, ethnic inequities exist in general health care, but evidence related to stroke is limited and conflicting. We assessed differences in access to and outcomes post stroke care by ethnicity. Methods: In a prospective, nationwide, multi-centre observational study, we recruited consecutive adult patients with confirmed stroke admitted to 28 hospitals between 1 May and 31 October 2018. Outcomes included: access to thrombolysis, endovascular thrombectomy, stroke-units, investigations, secondary prevention, inpatient/community rehabilitation; favourable functional outcome (modified Rankin Scale scores 0-2); quality of life (EQ5D-3L); stroke/vascular events; and death at three, six, and 12 months. Multivariate regression analysis was used to study associations Findings: 2,379 patients were identified and included in the analysis (mean age 75 (SD 13·7); 51·2% male; 76·7% European, 11·5% Māori, 4·8% Pacific peoples, 4·8% Asian). Stroke occurred at younger age and stroke risk factors were more prevalent in non-Europeans. Reduced access to acute stroke units (aOR=0·78, 95%CI, 0·60-0·97), swallow screen ≤24 hours of arrival (aOR=0·72, 0·53-0·99), and MRI imaging (OR=0·66, 0·52-0·85) were achieved less frequently in non-Europeans. Māori were less frequently prescribed anticoagulants (OR=0·68, 0·47-0·98). Pacific peoples received greater risk factor counselling. Fewer non-Europeans had a favourable outcome at three (aOR=0·67, 0·47-0·96), six (aOR=0·63, 0·40-0·98) and 12 months (aOR=0·56, 0·36-0·88), and more Māori had died by 12 months (aOR=1·76, 1·07-2·89). Interpretation: Stroke outcomes varied by ethnicity, with poorer outcomes for non-Europeans, especially Māori. In addition to increased baseline risks factors, the demonstrated ethnic disparities in accessing several key stroke interventions can explain, at least in part, the observed outcome differences. Further optimisation of stroke care targeting high-priority populations and cultural competence training are needed to achieve equity. Funding: New Zealand Health Research Council (HRC17/037). Declaration of Interest: DC, JD and JK who report grants from the Health Research Council of New Zealand during the conduct of the study; DC also reports grants from National Health and Medical Research Council, grants from Medtronic, grants from Amgen, grants from Stroke Foundation, grants from Academy of Science, grants from Heart Foundation, grants from CSIRO, grants from Victorian Agency for Health Innovation, grants from Boehringer Ingelheim, grants from Melbourne Health, grants from National Institute for Health Research UK, grants from Western Australian government, grants from South Australian government, outside the submitted work. MH reports an Appointed member of Waitemata District Health Board 2016 to 2019; no other relationships or activities that could appear to have influenced the submitted work. No other authors have anything to disclose. Ethical Approval: This study received ethics approval from the Central Region Health and Disability Ethics Committee (17CEN164).