Introduction: There are sparse data on the impact of socioeconomic status (SES) on the incidence of anthracycline cardiotoxicity.Aims: To examine the association of neighborhood-level SES factors with anthracycline cardiotoxicity.Methods: We included consecutive adult patients who underwent anthracycline-based chemotherapy from 2016 to 2019 for any type of cancer in the Montefiore Health System. The endpoint was the development of cardiotoxicity (defined as clinical heart failure or drop in left ventricular ejection fraction [LVEF]≥10% to LVEF<53%). We analyzed neighborhood-level SES measures (median household income [MHI], high school graduate rate, employment rate), and composite indices of neighborhood-level social disadvantage (the Social Vulnerability Index [SVI] and Area Deprivation Index [ADI]), with higher scores indicating worse neighborhood-level SES.Results: A total of 925 patients (22% Non-Hispanic White (NHW), 25% Non-Hispanic Black (NHB), 31% Hispanic, and 2% Non-Hispanic Asian) were included. During a median follow-up of 21 months, 116 patients (13%) developed cardiotoxicity. Patients who developed cardiotoxicity had significantly lower MHI, lower high school graduation rates, lower employment rates, higher SVI and ADI compared with patients who did not develop cardiotoxicity (all p<0.01). In multivariable adjusted Cox Proportional-Hazards models, MHI (1 quartile vs 4 quartile HR 2.1, p=0.024), SVI (HR 3.66, p=0.014) and ADI (HR 1.01, p=0.018) were significantly associated with a higher risk of cardiotoxicity development after adjusting for age, sex, cardiovascular risk factors, baseline LVEF, and anthracycline dose. ADI remained significantly associated with cardiotoxicity after adjustment for race/ethnicity (HR 1.01, p=0.046).Conclusions: In a large, socioeconomically diverse cohort of cancer survivors treated with anthracycline-based chemotherapy, SES indices were associated with the development of cardiotoxicity. ADI may be a better predictor of cardiotoxicity independent of race/ethnicity.