Background: We aim to compare the burden of cardiovascular disease risk factors and major adverse cardiac events and in‐hospital outcomes among young Black patients (aged 18–44 years) hospitalized in 2007 and 2017 using data obtained from the National Inpatient Sample database. Method and Results: Comparison of the sociodemographic characteristics, comorbidities, and inpatient outcomes, including major adverse cardiac events (all‐cause mortality, acute myocardial infarction, cardiogenic shock, cardiac arrest, ventricular fibrillation/flutter, pulmonary embolism, and coronary intervention), between 2017 and 2007 was performed. Multivariable analyses were performed, controlling for potential covariates. A total of 2 922 743 (mean age, 31 years; 70.3% women) admissions among young Black individuals were studied (1 341 068 in 2007 and 1 581 675 in 2017). The 2017 cohort had a younger population (mean, 30 versus 31 years; P <0.001), more male patients (30.4% versus 28.8%; P <0.001), and patients with higher nonelective admissions (76.8% versus 75%; P <0.001), and showed an increasing burden of traditional cardiometabolic comorbidities, congestive heart failure, chronic pulmonary disease, coagulopathy, depression, along with notable reductions in alcohol abuse and drug abuse, compared with the 2007 cohort. The adjusted multivariable analysis showed worsening in‐hospital outcomes, including major adverse cardiac events (adjusted odds ratio [aOR], 1.21), acute myocardial infarction (aOR, 1.34), cardiogenic shock (aOR, 3.12), atrial fibrillation/flutter (aOR, 1.34), ventricular fibrillation/flutter (aOR, 1.32), cardiac arrest (aOR, 2.55), pulmonary embolism (aOR, 1.89), and stroke (aOR, 1.53). The 2017 cohort showed a decreased rate of percutaneous coronary intervention/coronary artery bypass grafting and all‐cause mortality versus the 2007 cohort ( P <0.001). Conclusions: In conclusion, young Black patients have had an increasing burden of cardiovascular disease risk factors and worsened in‐hospital outcomes, including major adverse cardiac events and stroke, in the past decade, although with improved survival odds.