Abstract Background Both stroke and psychosis are independently associated with high levels of disability. However, psychosis in the context of stroke has been under-researched. To date, there are no general population studies on their joint prevalence and association. Aims To estimate the joint prevalence of stroke and psychosis and their statistical association using nationally representative psychiatric epidemiology studies from two high-income countries – United Kingdom and the United States – and two middle-income countries – Chile and Colombia, and, subsequently, in a combined countries dataset. Methods Prevalences were calculated with 95% confidence intervals. Statistical association between stroke and psychosis, and stroke and psychotic symptoms, was tested using regression models. Overall estimates were calculated using an individual participant level meta-analysis on the combined countries dataset. The analysis is available online as a computational notebook. Results The overall prevalence of probable psychosis in stroke was 3.81% [95% CIs 2.34 - 5.82] and stroke in probable psychosis was at 3.15% [95% CIs 1.94 - 4.83]. The adjusted association between stroke and probable psychosis was OR = 3.32 [95% CIs 2.05 - 5.38]. On the individual symptom level, paranoia, hallucinated voices, and thought passivity delusion were associated with stroke in the unadjusted and adjusted analyses. Conclusions Rates of association between psychosis and stroke suggest there is likely a high clinical need group who are under-researched and may be poorly served by existing services.