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Introduction Ruptured intracranial aneurysms (RIAs) are the most common cause of non-traumatic subarachnoid hemorrhage and carry a high burden of morbidity and mortality. While early diagnosis of unruptured intracranial aneurysms (UIAs) via neuroimaging can mitigate the risk through preventative measures, access to diagnostic pathways can be impacted by systemic socioeconomic factors. Patients who live in socioeconomically deprived neighborhoods do not access incidental or screening imaging as readily as do their more privileged counterparts, resulting in missed opportunities to diagnose UIAs before they progress to rupture. The role of socioeconomic determinants of health on the prevalence of prior UIA diagnosis in patients presenting with RIA is unknown. The goal of this study is aimed at estimating the proportion of patients with RIAs who had previously been diagnosed with UIA, and to examine the function of neighborhood deprivation, insurance status, and race/ethnicity on prior detection.Methods This was a retrospective cohort study using the Cosmos data resource (2015-2025). Adults (≥18) with a diagnosis code of RIA and Area Deprivation Index (ADI) data available were included. The primary outcome was documentation of an unruptured intracranial aneurysm diagnosis prior the ruptured intracranial aneurysm within 10 years. The exposures and stratification variables included the Area Deprivation Index (ADI), insurance category, sex, race/ethnicity, and smoking status, with age included as a covariate for adjustment in all models. ADI was analyzed in deciles and aggregated into quintiles (Q1 is least deprived and Q5 is most deprived). Analyses used aggregate counts exported from SlicerDicer tool in Cosmos. We calculated crude proportions overall and within strata, compared groups with χ 2 tests, and estimated unadjusted odds ratios (ORs) with Wald 95% CIs for key contrasts.Results We identified 28,677 RIAs, of which 42.4% had a prior UIA and 57.6% did not. Age peaked at 50-75 years in both groups, and a racial breakdown of the prior UIA group showed approximately 64% were White, 18% were Black, 5% were Asian, and 14% were classified as Other. Prior detection was more frequent in females than males (OR 1.24, 95% CI 1.18-1.31; p<0.001), and higher for those with Medicaid (OR 1.22, 95% CI 1.15-1.29; p<0.001). Prior detection declined from Q1 to Q5 (χ 2 p≈0.002; Q5 vs Q1 OR 0.90, 95% CI 0.82-0.99). White patients had higher odds of prior UIA detection than Asian patients (OR 1.31, 95% CI 1.24-1.38, p < 0.001).Conclusion Roughly 2 out of 5 RIA patients carried a prior UIA diagnosis. Female sex and lower neighborhood deprivation were associated with greater prior detection; White patients had higher prior detection than Asian patients, with no difference vs Black patients. A payer signal was observed, but cleaner categorization is needed. These results suggest inequities in access to pre-rupture screening and treatment of UIAs.Disclosures P. Prabhakar: None. A. Custozzo: None. A. Paul: 1; C; Microvention.