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Objective: To compare two population-based studies of intracerebral hemorrhage (ICH), collected 20 to 24 years apart, with regard to hemorrhage volumes, location, and stroke risk factors.Methods: All cases of spontaneous ICH among adult residents of the primarily biracial Greater Cincinnati/Northern Kentucky (GCNK) region were ascertained for 1988 and 7/2008-12/2012. Subject information including age, sex, race, Glasgow Coma Scale, and baseline blood pressure were recorded, along with medical history and prescription of anticoagulant and antiplatelet medications. ICH location was defined as deep, lobar, brainstem, or cerebellar. ICH volume was calculated by the ABC/2 method.Results: There were 170 cases of ICH in 1988 and 1101 cases in 2008-2012 fulfilling inclusion criteria. There were no significant differences in mean age (71.2 vs. 70.5 years) or sex (57.7% vs. 51.6% female), but there was a higher proportion of blacks in 2008-2012 compared with 1988 (23.5 vs. 13.5%, P=0.0045). Among the 2008-2012 cases there was significantly less history of ischemic stroke and non-ischemic stroke, and there were no significant differences in history of hypertension, diabetes mellitus, and current smoking. The 2008-2012 cases were prescribed more anticoagulants and antiplatelets. The distribution of ICH location was similar between the two groups. The ICH volumes appear to be lower in 2008-2012 than for 1988 for all hemorrhage locations except the brainstem; however, statistical significance was reached only for deep ICH (Table 1).Conclusions: Although the distribution of ICH location was unchanged between 1988 and 2008-2012, deep ICH volume was smaller in the more recent study. This reduction in hemorrhage size occurred despite significantly more anticoagulant and antiplatelet medications in 2008-2012. More research is needed to investigate factors related to ICH size and trends over time.