The relationship between lower socioeconomic status(SES) and poor cardiovascular outcomes is well-described, however there exists a paucity of data exploring this association in cardiogenic shock(CS). This study aimed to investigate whether any disparities exist between SES and the incidence, quality-of-care or outcomes of CS patients attended by emergency medical services(EMS).This population-based cohort study included consecutive patients transported by EMS with CS between January 1st 2015 and June 30th 2019 in Victoria, Australia. Data were collected from individually linked ambulance, hospital and mortality datasets. Patients were stratified into SES quintiles using national census data produced by the Australia Bureau of Statistics.A total of 2 628 patients were attended by EMS for CS. The age-standardized incidence of CS amongst all patients was 11.8(95% confidence interval [CI], 11.4-12.3) per 100 000 person-years, with a stepwise increase from the highest to lowest SES quintile(lowest quintile 17.0 vs. highest quintile 9.7 per 100 000 person-years, p-trend < 0.001). Patients in lower SES quintiles were less likely to attend metropolitan hospitals and more likely to be received by inner regional and remote centers without revascularization capabilities. A greater proportion of the lower SES groups presented with CS due to non-ST elevation myocardial infarction(NSTEMI) or unstable angina pectoris(UAP), and overall were less likely to undergo coronary angiography. Multivariable analysis demonstrated an increased 30-day all-cause mortality rate in the lowest 3 SES quintiles when compared to the highest quintile.This population-based study demonstrated discrepancies between SES status in the incidence, care-metrics and mortality rates of patients presenting to EMS with CS. These findings outline the challenges in equitable healthcare delivery within this cohort.