ABSTRACT NUMBER: ESOC2026A302 VASCULAR RISK AND CEREBRAL SMALL VESSEL DISEASE IN PEOPLE EXPERIENCING HOMELESSNESS: A CASE - CONTROL MRI STUDY

Abstract Background and aims People experiencing homelessness (PEH) have high rates of multimorbidity, frailty and premature mortality. Vascular risk factors and cerebral small vessel disease (cSVD) are prevalent in this population but have not previously been quantified relative to housed controls. We aimed to compare vascular risk and white matter hyperintensity (WMH) burden between PEH and housed controls. Methods PEH were recruited from homeless services alongside age-, sex- and education-matched housed controls. Vascular risk burden was quantified using the Framingham Risk Score (FRS). Participants underwent brain MRI, with WMH burden quantified using an automated machine-learning pipeline and visually grading using the Fazekas scale. Comparisons were performed using Wilcoxon rank-sum tests. Statistical analyses were conducted in R (v4.5.2). Results 38 PEH and 19 controls were recruited and were well matched for age, sex and education. There was no statistically significant difference in FRS between PEH and controls (p = 0.583). Total WMH burden did not differ significantly between groups using automated or visual quantification methods; however, a trend toward greater periventricular WMH burden was observed in PEH (p = 0.075). Automated and visual WMH measures were correlated (Spearman’s ρ = 0.566, p < 0.0001). Conclusions In this first controlled comparison, PEH did not demonstrate a significantly higher vascular risk or WMH burden compared with housed controls, although a trend toward greater periventricular WMH burden was observed. This may reflect limited statistical power and heterogeneity amongst PEH. Larger controlled studies are needed to further characterise cerebrovascular disease amongst PEH and inform prevention strategies. Conflict of interest Georgia Richard: This researcher was funded by the Health Research Board (ICAT-2022-001) and the ICAT Programme, which is supported by the Health Service Executive, National Doctors Training and Planning, the Health and Social Care, Research and Development Division, the Northern Ireland Medical and Dental Training Agency, the Department of Agriculture, Food and the Marine and the College of Anaesthesiologists of Ireland. Joseph Harbison: nothing to disclose. Colin Doherty: nothing to disclose. Cliona Ni Cheallaigh: nothing to disclose.