Stroke is a leading cause of death and disability, and can be devastating when occurring in young adults. These patients have a long-life expectancy after stroke, and the costs of long-term care challenge healthcare systems. A recent review highlighted higher incidence of stroke in indigenous populations of developed countries [1], while evidence suggests that stroke incidence is rising in young adults [2]. Differences remain between countries and ethnic groups [3], [4] and specifically, among Pacific Islanders [5], [6], [7], [8]. Up to now, very few studies have described the specific characteristics and cause of stroke among young Pacific people [9].

French Polynesia (FP) comprises 121 geographically dispersed islands and atolls spanning more than 3521 square kilometers in the South Pacific Ocean, with a total population of 278,786 (2022 census), nearly 69% of whom reside on the island of Tahiti alone. Its multi-ethnic population is made up of approximately 85% Māʻohi (meaning indigenous, originally from the Polynesian Islands, more commonly self-referred as Polynesian) and people of mixed descent, 10% Popa’a (foreigners, mostly mainland France) and 5% of Asian origin [10].

FP is located in the middle of the so-called Polynesian triangle, which connects Hawaii, New Zealand and Rapa Nui (Easter Island). Māori, Hawaiians (Kanaka Maoli), Tongans, Samoans, Niueans and Māʻohi all share linguistic, cultural, and genetic roots [11], and represent approximately two million people.

Despite the geographical challenges posed by its wide territory, FP has made significant strides in healthcare accessibility to ensure that almost all patients victims of stroke are hospitalized in its sole stroke unit, at the Centre Hospitalier de Polynésie Française, in Tahiti [12]. Access to comprehensive stroke care is free of charge for residents.

A French overseas territory since 1842, FP's healthcare system is closely linked to and modeled on that of France. Moreover, all FP's physicians are trained in mainland France. As previous data on stroke in FP are lacking, all recommendations on stroke management come from studies carried out in mainland France.

A 2022 preliminary epidemiological study (Buon et al., in press) revealed among 336 first-ever ischemic stroke a median age of 63 years old (interquartile range: 53–72), and 92 (27.4%) patients under 55 years old, consistent with trends observed in other Pacific countries [6], [8], [13].

Given the significant proportion of young stroke patients in FP, a higher incidence of stroke in indigenous people and an increasing incidence in young adults, it appears critical to further identify the risk factors and specific etiologies of stroke in this population. In this study, we aimed to compare young patients with ischemic stroke in FP with a cohort in Toulouse, mainland France.