Background Socioeconomic status influences health outcomes, including cerebrovascular diseases. Patients from socioeconomically deprived areas may present with more severe conditions due to delayed access to care. This study evaluates the association between neighborhood-level deprivation, measured by the Area Deprivation Index (ADI), and the treatment of ruptured intracranial aneurysms (RIAs) compared with unruptured intracranial aneurysms (UIAs) across multiple centers. Methods This retrospective cohort study analyzed data from 4517 patients treated for cerebral aneurysms at 10 US comprehensive stroke centers between 2018 and 2024. Patients were stratified by national ADI decile based on their residential addresses. Multivariable logistic regression was used to examine the relationship between ADI and aneurysm rupture (reference being unruptured aneurysms) and controlled for age, sex, smoking history, family history, and race. Results Of 4517 total patients, 1260 (27.9%) underwent treatment of RIAs. Multivariable analysis confirmed ADI as an independent predictor of presentation for treatment of RIA (odds ratio (OR)=1.100, 95% confidence interval (CI)=1.068–1.133, P<0.0001) after adjusting for age, sex, smoking history, and race. This corresponds to a 10% increase in likelihood of presenting for treatment of a ruptured vs unruptured intracranial aneurysm with each ADI decile. Conclusion Socioeconomic deprivation independently predicts treatment of RIAs compared with the treatment of UIAs. These findings highlight disparities in aneurysm detection and management, emphasizing the need for targeted preventive care and accessible screening programs to mitigate the impact of socioeconomic disadvantage on cerebral aneurysm outcomes.

Introduction: Ruptured intracranial aneurysms (RIAs) are a significant cause of morbidity and mortality. While individual-level risk factors for aneurysmal subarachnoid hemorrhage (aSAH) are well established, the influence of meteorological variables has been widely debated but remains unclear. Methods: We retrospectively analyzed 1504 endovascularly treated intracranial aneurysm cases from two stroke centers (2018 to 2024). We matched daily weather data to presentation dates. We used variance inflation factor (VIF) analysis to remove collinear features. Multivariable logistic regression models were adjusted for age and sex. We developed extreme gradient boosting (XGBoost) models using weather variables alone and in combination with demographic covariates (age, sex, race, smoking status, and family history). Results: Of 1504 cases, 377 (25.1%) presented with rupture. In univariate logistic regression, greater humidity (odds ratio [OR] 0.988 per 1% relative humidity, 95% confidence interval [CI] 0.979 to 0.998, p = 0.0135) and greater ultraviolet (UV) index (OR 0.951 per index unit, 95% CI 0.914 to 0.990, p = 0.0146) were associated with reduced odds of rupture, whereas greater snow depth (OR 1.360 per inch, 95% CI 1.068 to 1.731, p = 0.0126) and advanced moon phase (OR 1.589 per full lunar cycle, 95% CI 1.064 to 2.373, p = 0.0237) were associated with increased odds. On multivariable analysis, only female sex remained protective (OR 0.605, 95% CI 0.386 to 0.949, p = 0.0285), and greater sea level pressure trended toward lower odds of rupture without reaching significance (OR 0.962, p = 0.0523). Findings were consistent in a full-cohort, center-adjusted sensitivity analysis. The weather-only XGBoost model yielded an area under the receiver operating characteristic curve (AUC) of 0.560 and a recall of 78%, which improved to an AUC of 0.590 and a recall of 83% after adding demographic variables. SHapley Additive exPlanations (SHAP) analysis identified precipitation and cloud cover as key meteorological features. Conclusions: Several weather variables correlated with rupture risk in univariate analysis, but overall predictive value was limited. Machine learning improved sensitivity while confirming patient features as the dominant contributors. Weather on the day of presentation was not significantly associated with rupture.