<h3>Purpose</h3> Given an increased interest in the intersection of socioeconomic status (SES) and healthcare, there have been efforts to quantify individual and community factors that influence health outcomes. Distressed Communities Index (DCI) is one effort that assigns a score of 0 (not distressed) to 100 (severely distressed) to a zip code based on several SES determinants. We aimed to evaluate the impact of SES on preoperative characteristics and postoperative outcomes in lung transplantation (LTx) through the utilization of DCI. <h3>Methods</h3> All adult patients (pts) undergoing LTx at a quaternary care hospital between 2017-2019 were eligible for inclusion of this retrospective cohort study. Pts were stratified by their home zip code as being distressed (DS), DCI score > 60, or not distressed (ND), DCI score < 60. Categorical variables were analyzed with Chi-square tests and continuous variables with the median test. Kaplan-Meier method and logrank techniques were utilized. <h3>Results</h3> A total of 73 pts with a median age of 64 [IQR: 59-68] years met criteria for inclusion. The two cohorts consisted of 24 (33%) DS and 49 (67%) ND pts. The majority of pts were male in both cohorts, DS (75%) and ND (67%). Co-morbidities in the DS and ND groups included hypertension, 54% vs 59%, and diabetes, 45% vs 49%. The most common reason for LTx was idiopathic pulmonary fibrosis in the DS (42%) and ND (45%) group. Preoperatively, DS pts had a longer Six Minute Walk Test (274 vs 196m, p=0.05) with lower FEV1% predicted, (31% vs 47%, p=0.03). Median lung allocation score for the DS and NS cohorts was 48.3 and 47.6 respectively. Length of stay following LTx was similar in the DS and ND cohorts, 19 vs 14 days (p=0.28), and the majority of pts were discharged directly home, 58% vs 63% (p=0.73). There was no statistically significant difference between the DS and ND cohorts with regards to complications in the first year postoperatively including rejection (25% vs 18%), re-hospitalization (67% vs 71%), renal insufficiency (38% vs 31%), and pneumonia (58% vs 49%). Thirty-day survival was similar between the DS and ND recipient, 96% vs 98%, as was 30-month survival, 44% vs 59% (p=0.39). <h3>Conclusion</h3> While DCI was associated with differences in baseline clinical profile, it was not associated with differences in survival in pts undergoing LTx. DCI, as a marker of SES, was not indicative of worse outcomes in pts undergoing LTx.