Abstract Body (Do not enter title and authors here): Background:
Ischemic heart disease (IHD) remains a leading cause of death in the United States, with disproportionate mortality among racially and socially marginalized groups. This study examines the intersection of race, county-level social vulnerability, and premature IHD mortality among elderly populations from 2010 to 2020.

Hypothesis:
We hypothesize that higher county-level social vulnerability is associated with increased premature IHD mortality among adults aged 65 and older, with the strength of this association differing by racial and ethnic group.

Methods:
We analyzed CDC WONDER data for age-adjusted IHD mortality rates (AAMR) in adults ≥65 years, stratified by race/ethnicity (American Indian/Alaska Native [AIAN], Asian/Pacific Islander [API], Black, Hispanic, and White). County-level Social Vulnerability Index (SVI) quartiles were linked to mortality data. We compared mean AAMRs between low (Q1) and high (Q4) SVI quartiles within each race using t-tests. Linear regression and interaction models assessed whether the relationship between SVI and AAMR varied by race.

Results:
In the highest SVI quartile (Q4), the counties with the highest AAMRs were: Neshoba County, MS (AIAN: 3297/100,000), Mississippi County, AR (Black: 2885; White: 2588), Terry County, TX (Hispanic: 1989), and Yuba County, CA (API: 1040). Mean AAMRs were significantly higher in Q4 than Q1 for API (p = 0.0208), Black (p < 0.0001), Hispanic (p < 0.0001), and White (p < 0.0001) groups. The AIAN group showed no significant difference (p = 0.82). This disparity trend was consistent across all races except AIAN. In pooled regression models, SVI was positively associated with AAMR (β = +39.6, p < 0.001). Interaction terms revealed that the SVI effect was most pronounced in the Hispanic group (β = +134.6, p < 0.0001), followed by White, Black, and API groups. No significant interaction was observed for AIAN.

Conclusion:
Social vulnerability is a strong predictor of ischemic heart disease mortality in elderly Black, Hispanic, White, and API populations. The Hispanic group exhibited the steepest increase in mortality with rising SVI, emphasizing the need for targeted intervention in high-SVI regions. The AIAN group showed a reversed trend, possibly due to small sample size or geographic outlier effects. These findings underscore the urgency for place- and race-conscious public health strategies to mitigate cardiovascular mortality disparities in structurally vulnerable populations.