Background:Only 20-30% of Intracerebral Hemorrhage (ICH) survivors achieve functional independence. We investigated if neighborhood socioeconomic disadvantage (NSD) mediated by cerebral small vessel disease (CSVD) is associated with post-ICH functional outcomes.Methods:Clinical and imaging data were extracted from electronic medical records and 90-day modified Rankin Score (mRS) was obtained from prospectively collected stroke registry at a large hospital system. CSVD was assessed based on MRI markers from 1-year before to 30 days after the ICH event and was scored from 0-4 with severe CSVD (S-CSVD) ≥ 2. Exact patient addresses were geocoded, and state-level Area Deprivation Index (ADI) was calculated, with high NSD (H-NSD) categorized as the top 15% of ADI scores. The outcome was severe disability or death (SDD) categorized as 90-day mRS score ≥4. Multivariate logistic regression models were fitted, and mediation was evaluated by structural equation modeling. Odds ratios (OR) and 95% confidence intervals (CI) are reported.Results:Final analysis included 367 patients (mean age: 65 years, 49.7% female, median presentation ICH Score: 1) with complete data. We found significant associations between older age, Black race, S-CSVD, H-NSD, hematoma volume, presence of ventricular hemorrhage, presentation systolic blood pressure (SBP), and ICH score with SDD (P<0.05). In a multivariate model adjusted for age, SBP, ICH score and other important clinical co-variates, SDD was significantly and independently associated with both H-NSD (OR, CI: 2.03, 1.05 - 4.23) and S-CSVD (OR, CI: 1.93, 1.12 - 3.35). Our data did not demonstrate an association between CSVD and NSD; and S-CSVD did not mediate the relationship between H-NSD and SDD.Discussion:In addition to known clinical factors, NSD, as measured by the ADI, and CSVD were independently associated with poor ICH outcomes. Potential causal pathways between H-NSD and poor ICH outcomes need to be further evaluated.