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Introduction: Direct comparisons of stroke risk factors and rates of acute stroke treatment between Asians, Blacks and Whites are limited due to a lack of racial diversity in typical hospital catchment areas.Methods: Consecutive patients with ischemic or hemorrhagic stroke (intracerebral [ICH] or subarachnoid hemorrhage [SAH]) admitted to a single, comprehensive stroke center located in a racially diverse, underserved metropolitan area were prospectively enrolled in a registry between 9/2014-2/2017. Stroke risk factors, admission NIHSS, insurance status and acute stroke treatments (including IV tPA and/or mechanical thrombectomy) were compared between Asian, White and Black patients.Results: Of 1045 stroke patients, 170 (16%) were Asian, 226 (22%) were Black and 649 (62%) were White. Asians had significantly higher rates of ICH than Blacks or Whites (17% versus 6% and 8%, respectively, P<0.001), while Blacks had higher rates of SAH than other race groups (12% versus 3% among Asians and Whites, P=0.002). Compared to Whites and Asians, Blacks were younger, more often female and had higher BMI (body mass index) than other race groups, though they had lower rates of hyperlipidemia (all P<0.05). Asians and Blacks were more than twice as likely to be uninsured or on Medicaid than whites (28%, 27% and 11%, respectively; P<0.001). Rates of IV tPA use among patients with ischemic stroke were significantly lower in Blacks (3%) than Asians (10%) or Whites (10%) after adjusting for NIHSS, anticoagulation and insurance status (P=0.002). While mechanical thrombectomy occurred more often in Asians (23%) and Blacks (23%) than whites (15%), this difference was non-significant after adjusting for NIHSS. Good discharge disposition (home, acute or home rehabilitation) was similar across racial groups after adjusting for age and NIHSS.Conclusions: In a single site study with minimal geographic/environmental heterogeneity, Asians and Blacks had higher rates of hemorrhagic strokes than Whites and higher rates of being underinsured. Rates of IV tPA utilization were lowest among Blacks, though rates of mechanical thrombectomy were similar across races. Lower rates of IV tpa use appear related to factors other than insurance status or treatment bias.