Abstract Body (Do not enter title and authors here): Background: Exploring the risk of young-onset stroke (YOS) in Asian Americans and Pacific Islanders (AAPIs), our study helps fill a critical gap in medical literature. By identifying unique risk factors and trends, the findings can guide early identification and targeted interventions for young AAPI individuals at high risk of stroke.

Method: AAPIs aged 18-44 with and without YOS hospitalization were retrospectively identified from the National Inpatient Sample (2016-2020). Study population, comorbidities, and outcomes were queried using ICD-10-CM codes. All-cause in-hospital mortality (ACIHM) was the primary outcome and secondary outcomes were measures of healthcare resource utilization. Multivariable regression analysis was performed to analyze cardiovascular disease risk (CVD) factors as predictors of YOS and associated all-cause in-hospital mortality (ACIHM). Linear-by-linear trend analysis was performed. Statistical significance was defined at p<0.05.

Result:
Of 1,629,064 young AAPIs hospitalized between 2016 and 2020, 9325 had YOS (0.6%), with an overall increasing prevalence year by year (0.5% in 2017 to 0.7% in 2020). Demographically, the YOS had a higher average age (38 vs. 32 years) and a male majority. YOS hospitalizations had the highest prevalence of comorbidities (hypertension, hyperlipidemia, obesity, diabetes mellitus, and smoking). Based on sex, females had an upward trend in YOS admissions (0.3% in 2016 to 0.4% in 2020) while nonsignificant in males. Trends in ACIHM were nonsignificant (p=0.279) overall, but by sex, it showed an overall decrease in males (11.1% in 2016 to 0.5% in 2020) and an overall increase in females (4.5% in 2016 to 11.5% in 2020).
ACIHM was higher in the YOS cohort (9.4% vs. 0.3%), with a longer stay (5 vs 2 days) and more expense (94,712 USD vs. 25,637 USD). Comorbidities of hypertension, both complicated and uncomplicated, hyperlipidemia, and peripheral vascular disease significantly predicted the odds of stroke by 7.14, 6.29, 1.85, and 5.94. Hyperlipidemia was protective against ACIHM in YOS hospitalizations (OR: 0.24 [0.13-0.43]).

Conclusion: Young AAPIs have an increasing risk of YOS each year, with higher rates and odds seen with certain CVD risk factors.