Abstract Body (Do not enter title and authors here): Introduction: Area-based social determinants of health (SDOH) are associated with higher risk for acquired heart disease. However, the impact of area-based SDOH on clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) has not been previously studied.

Hypothesis: Residing in an area with lower median household income and a higher social deprivation index (SDI) are independently associated with adverse outcomes in patients with HCM.

Methods: This study included 4,483 adult patients with HCM from five Sarcomeric Human Cardiomyopathy Registry (a multi-center prospective registry of patients with HCM) sites in the US followed for a median [IQR] of 4.0 [1.0-8.5] years. The patients’ residential address was geocoded at the zip code level to characterize median household income and SDI. SDI is based on various social factors (such as income and education), with a higher score reflecting more deprivation. Multivariate models, adjusting for sex, age, hypertension and body mass index were used to determine the independent association of household income and SDI on ventricular arrhythmias (VA), heart failure (HF), and an overall composite outcome (VA, HF, atrial fibrillation, death, and stroke).

Results: Median age at diagnosis was 48.3 [32.0-60.4] years with 42.0% female. Median household income was $90,000 [60,000-110,000] and median SDI was 25 [10-55]. Adjusted hazard ratios per $10,000 higher income were 0.96 (95% CI 0.93-1.00, p=0.03) for VA, 0.91 (95% CI 0.90-0.93, p <0.01) for HF, and 0.95 (95% CI 0.94-0.96, p <0.01) for the composite outcome. Adjusted hazard ratios per 10 units higher SDI (more deprived) were 1.07 (95% CI 1.03-1.12, p<0.01) for VA, 1.06 (95% CI 1.04-1.08, p <0.01) for HF, and 1.05 (95% CI 1.03-1.06, p <0.01) for the composite outcome. The associations of SDI and income on clinical outcomes were similar regardless of sarcomere gene variant status.

Conclusions: Residing in an area with lower median household income and higher SDI were independently associated with adverse outcomes in patients with HCM. These findings extend observations from acquired cardiovascular disease and highlight the need to address adverse SDOH to reduce health disparities and improve outcomes in patients with HCM.