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Introduction:Stress-induced cardiomyopathy (SIC), known as Takotsubo Cardiomyopathy, presents with chest pain and ECG changes suggestive of an acute myocardial infarction, triggered by physical or emotional stress. SIC has a higher incidence in Caucasians (CAUC) than in African Americans (AA). It is unclear whether this disparity is due to a racial predisposition, selection bias or a consequence of environmental factors.Hypothesis:We hypothesize that people from a lower socioeconomic strata (SES) have a lower incidence of SIC. Furthermore it is possible that the incidence of SIC could be similar among CAUC and AA at the same SES. Stress pre-conditioning maybe protective in preventing SIC among AA.Methods:Data of patients with discharge diagnosis of SIC were extracted from the Myocardial Infarction Data Acquisition System (MIDAS) spanning the period from 2006 through 2015. The incidence of SIC amongst CAUC and AA was compared per 100,000 NJ population. The incidence of SIC in CAUC and AA was examined across income brackets. Comparisons between CAUC and AA were performed with two-sample proportion tests.Results:During the study period CAUC had an overall higher incidence of SIC compared to AA, 0.017% vs 0.0084% per 100,000 population (p-value < 0.0001). This difference persisted after logistic regression adjustment (P=0.0064). CAUC in the income brackets 30-40k had lower incidence of SIC than those in 60-80k (P=0.0156) and those with income 60-80k had lower incidence of SIC than those with income 80-100k. AA with income between 30-60k had a lower incidence of SIC than CAUC (P=0.0330).Conclusions:In this study only CAUC exhibited a trend towards less SIC as a function of lower income level. This was not observed amongst AA however, compared to previously published data AA had a lower incidence of SIC. Our study suggests that SES has a protective effect amongst CAUC, however AA may have other, yet to be defined, stress pre-conditioning factors that are protective.