Abstract Body: Background: Area-level social determinants of health (SDOH) are associated with earlier onset of heart failure (HF). However, the extent to which adverse SDOH cluster in geographic communities and contribute to earlier onset of HF, particularly among minoritized populations, is not known.

Methods: Patients hospitalized with new-onset HF in the Get With The Guidelines-HF Registry (2017-19) were included. K-means clustering identified 4 groups of patient 5-digit residential zip code areas with similar area-level SDOH (education, income, employment, housing quality, healthcare access, and environmental factors). Linear regression adjusted for sex, region, and year of admission examined associations between area-level SDOH groups and age of HF onset overall and stratified by self-identified race and ethnicity.

Results: The 74,616 patients with new-onset HF belonging to one of the 4 area-level SDOH clusters differed had substantial heterogeneity in patient-level demographic and HF characteristics (Table). Mean (SD) age of HF onset was universally lowest in C3, ranging from 60.8y in NHB to 67.2y in NH Asian. Even within area-level SDOH clusters, racial and ethnic differences in HF onset age persisted. In the highest income cluster (C1), NHB patients and Hispanic patients had earlier age of HF onset (by 11.3 [95% CI 10.6, 12.1] and 7.9 [7.1, 8.7] y, respectively) compared with NHW patients.

Conclusions: Areas with adverse SDOH experience greater burden of and earlier HF onset with pervasive and widespread racial and ethnic disparities in age of incident HF hospitalization. Incorporating area-level SDOH measures may improve identification of HF risk. Disparities in age of HF onset persisted in areas with more favorable SDOH, suggest that structural and systemic factors continue to perpetuate health inequalities. Identifying at-risk communities and designing multi-level interventions are needed to equitably prevent or delay HF onset.