Abstract Body: Introduction: While intracranial hemorrhage (ICH) is uncommon in young adults (18-55), its incidence is on the rise. While the reasons for this increase are multifactorial, there is likely a contribution from the known rise in traditional vascular risk factors (VRFs) among the general young adult population. We aimed to examine the prevalence of VRFs among young patients with ICH and evaluate for racial and sex disparities in VRF burden.

Methods: Data of patients hospitalized with stroke between January 2014 and December 2023 were collected by Get With the Guidelines-Stroke hospitals participating in the Florida Stroke Registry. Young patients aged 18-55 with a diagnosis of ICH were included and separated into two age groups: 18-35 and 36-55. VRFs included hypertension, diabetes, kidney disease, smoking, drug or alcohol abuse, antithrombotic medication use, and sleep apnea. Polymorbidity was defined as the presence of three or more VRFs.

Results: 9541 young ICH patients were included (39% female, 41% White, 17% Hispanic, 33% non-Hispanic Black), and 1240 (13%) of these patients were aged 18-35. The prevalence of each VRF was higher among patients aged 36-55 vs 18-35 (all p values <0.001) with the exception of kidney disease. Only 48% of patients 18-35 and 20% of patients 36-55 had no VRFs. Black patients with ICH had a significantly higher prevelance of polymorbidity than white or Hispanic patients (19% vs 17% vs 15%, p<0.001) and this disparity was more pronounced among patients aged 18-35 (11% vs 6% vs 3%, p<0.001). Male ICH patients demonstrated higher rates of polymorbidity than females (19% vs 15%, p<0.001). In temporal trends analysis, the prevalence of polymorbidity did not significantly change over the interval in either the 18-35 (p=0.3) or 36-55 (p=0.09) age groups. While the prevalence of hypertension increased in both age groups over the time interval (from 24% to 33% in patients 18-35 and from 65% to 68% in patients 36-55), this was offset by decreases in smoking (from 20% to 9% in patients 18-35 and from 22% to 17% in patients 36-55).

Conclusions: VRFs are common among young ICH patients, and while the prevalence of hypertension increased during the study interval, the overall burden of traditional risk factors did not significantly change. Our findings highlight the persistent need for primary prevention strategies against ICH among young adults and identify specific at-risk populations that would benefit from targeted interventions.