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Introduction:Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiac disease. In small studies race has been associated with disparities in septal reduction therapy (SRT) but little is known about the association of social risk factors with HCM treatments and outcomes.Methods:A retrospective cohort of admissions for HCM in the National Inpatient Sample from 2012-2018 was identified using ICD-9-CM and ICD-10-CM diagnosis codes. SRT and implantable cardioverter-defibrillator (ICD) procedures were identified using ICD-9-CM and ICD-10-CM procedure codes. Logistic regression controlling for social risk factors, Elixhauser comorbidities, pre-existing ICD, and clustering by hospital-year was used to determine the association of social risk factors with HCM procedures and in-hospital mortality.Results:We identified 60,227 patients with HCM; 45.82% with obstructive HCM (oHCM). Among them, 57.25% were female, 18.65% were Black, 26.75% were in the lowest ZIP income quartile, and 14.89% lived in rural areas. ICD procedures were done on 3.07% of patients with HCM. Septal myectomy and alcohol septal ablation were received by 6.89% and 2.21% of patients with oHCM, respectively. The in-hospital mortality rate was 3.32% for HCM admissions. Compared to White patients, Black patients were less likely to receive septal myectomy (odds ratio [OR] 0.56, 95% confidence interval [0.45-0.70], p<0.001) and more likely to receive ICD procedures (OR 1.17 [1.01-1.36], p=0.03). Patients in the lowest income quartile were less likely to receive septal myectomy (OR 0.81 [0.68-0.98], p=0.03) and ICD procedures (OR 0.83 [0.71-0.98], p=0.02). Rural patients were more likely than urban patients to receive septal myectomy (OR 1.39 [1.17-1.64], p<0.001) and to die during hospitalization (OR 1.38 [1.19-1.59], p<0.001). Female patients were less likely to receive ICD procedures (OR 0.69 [0.62-0.76], p<0.001) but more likely to die during hospitalization (OR 1.19 [1.07-1.31], p<0.001).Conclusions:Among 60,227 patients with HCM, social risk factors were associated with significant disparities in in-hospital mortality and in receiving septal myectomy and ICD treatment. Further research is required to identify and address the sources of these disparities.