Abstract Body: Background: Health disparities regarding heart failure (HF) incidence by age, race, sex at birth, socioeconomic status (SES) and their intersections remain under-researched.

Methods: We harmonized data from nine cohorts (WHI, FOHS, ARIC, Health ABC, REGARDS, CARDIA, JHS, CHS, and MESA). We performed a descriptive study of the cohort calculating incidence rates (IR) and incidence rate ratios (IRR). Age was defined at time zero for each cohort. Participants who identified as Black or white were included. SES was categorized as low or high based on both an educational attainment of some college/vocational training or less and an income, using household size and Official Poverty Measure (OPM) less than 200%. We stratified by age (≤65 vs. >65 years) and evaluated IRs and IRRs, standardized by age (using 10-year intervals), sex, and race, depending on the comparison.

Results: A total of 9700 incident HF cases occurred among 96000 participants free of HF at baseline followed up for a median of 13.7 years. Black participants had a slightly lower overall incidence of HF than Whites (IRR: 0.93, 95% CI: 0.89-0.97). We observed a higher risk of HF among Black participants≤65 years of age (IRR: 1.22, 95% CI: 1.14-1.31) compared to Whites. Conversely, Black individuals >65 years of age had a lower incidence than Whites (IRR: 0.75, 95% CI: 0.71-0.80). Women had a lower incidence of HF than men (IRR: 0.66, 95% CI: 0.63-0.68), overall and in age strata. Low, as compared to high SES individuals had a higher incidence of HF (IRR: 1.67, 95% CI: 1.60-1.74. Among those ≤65, low SES Black men (IRR: 2.16, 95% CI: 1.81, 2.56) and low SES White men (IRR: 1.60, 95% CI: 1.35,1.91) had the highest incidence rate of HF compared to high SES White men.

Conclusion: Both Black and White low SES groups are at the highest HF risk. Effect modification by age is apparent for race differences but a limitation of present descriptive analysis is that competing risk of death is not accounted for. 10-year cumulative incidence risk and its differences based on race, sex, and/or SES by accounting for competing risk of death are planned.