Background and Purpose— Stroke is associated with severe economic consequences. This is the first study to investigate in younger survivors the household economic burden of stroke. Methods— A multicenter, 3-year prospective cohort study was conducted of younger (18–65 years) survivors in Australia. Pre- and poststroke patterns of income and hardship were evaluated and multivariable logistic regression identified the predictors of economic hardship after stroke. Results— Four hundred fourteen participants were followed up over 12 months after stroke. The variables that independently predicted economic hardship after stroke were: female (OR, 2.94; 95% CI, 1.52–5.70), hazardous alcohol consumption (OR, 2.28; 95% CI, 1.00–5.20), manual occupation (OR, 1.88; 95% CI, 1.07–3.30), lack of health insurance (OR, 2.01; 95% CI, 1.12–3.60), and prior hardship (OR, 3.93; 95% CI, 2.12–7.29), whereas concessional status (OR, 0.50; 95% CI, 0.26–0.95) and more social contacts per week (OR, 0.99; 95% CI, 0.98–1.00) reduced hardship likelihood. Conclusions— Higher prestroke income did not buffer hardship after stroke nor did clinical, health service, or disability factors. Policies to reduce inequalities after stroke would be best aimed at socioeconomic targets.