Objective: To determine black-white differences in 1-year recurrent stroke and 30-day case fatality following a recurrent stroke in older US adults. Methods: We conducted a retrospective cohort study using a 5% random sample of Medicare beneficiaries with fee-for-service health insurance coverage who were hospitalized for ischemic stroke between 1999 and 2013. Hazard ratios (HR) for recurrent ischemic stroke and risk ratios (RR) for 30-day case fatality comparing blacks to whites were calculated with adjustment for demographics, risk factors, and competing risk of death, where appropriate. Results: Among 128,789 Medicare beneficiaries having an ischemic stroke (mean age 80 years [SD 8 years], 60.4% male), 11.1% were black. The incidence rate of recurrent ischemic stroke per 1,000 person-years for whites and blacks, respectively, was 108 (95%CI 106-111) and 154 (95%CI 147-162). The multivariable-adjusted hazard ratio for recurrent stroke among blacks compared with whites was 1.36 (95%CI 1.29-1.44). The case fatality following recurrent stroke for blacks and whites, respectively, was 21% (95%CI 21-22%) and 16% (95%CI 15-18%). The multivariable-adjusted relative risk for mortality within 30 days of a recurrent stroke among blacks compared with whites was 0.82 (95%CI 0.73-0.93). Conclusions: The risk of stroke recurrence among older Americans hospitalized for ischemic stroke is higher for blacks when compared to whites, while 30-day case fatality following recurrent stroke remains lower for blacks.