Introduction - The health impact of strokes continues to grow, particularly among people under 45 and in developing countries. Mayotte lacks epidemiological data specific to its population regarding this condition and its risk factors. In this context, a study was conducted to calculate the incidence and mortality rates of stroke in Mayotte and to investigate its risk factors and etiology. Methods - This was a single-center, retrospective, descriptive study. The study population consisted of patients admitted to the emergency department of the Mayotte Hospital Center for stroke between 2013 and 2017. Results - A total of 553 patients were enrolled, including 463 with ischemic stroke. The standardized incidence rate was 159.9 per 100,000 inhabitants. The standardized incidence of ischemic strokes was 125.9 per 100,000. Acute-phase mortality was 20.5 per 100,000. Strokes were ischemic in 78% of patients; 22% were hemorrhagic, of which 13% were cardioembolic in nature, 15% were caused by atherosclerosis of large vessels, 42% were due to microangiopathy, and 30% were of undetermined cause. The mean age at onset was 62 years for men and 63 years for women. The population under 65 years of age accounted for 52%. The prevalence of hypertension was 88.5%, and only 57% of hypertensive patients were receiving treatment. Antihypertensive treatment was significantly more common among patients covered by Social Security. The prevalence of diabetes was 33%, with a mean HbA1c level of 9%. Diabetic complications affected patients without health insurance significantly more. The rate of overweight or obese patients was 63%. Conclusion - These results highlight the distinct characteristics of the Mayotte population, which appears to be more susceptible than the mainland population to cerebrovascular events, particularly those involving microcirculatory damage. The significance of risk factors such as hypertension and diabetes is undeniable. The similarity of our results to those from other overseas departments and regions leads us to hypothesize that the island environment, in conjunction with changing lifestyles, plays a role. Comparison with studies conducted in sub-Saharan Africa also suggests a role for genetic predisposition in susceptibility to risk factors.