Abstract 4373496: Sudden Cardiac Death in Women: A 21-Year Trend Analysis by Race and Age Group Reveals Persistent Disparities

Introduction: Sudden cardiac death (SCD) is a leading contributor to cardiovascular mortality in women, yet long-term trends have been understudied particularly across menopausal transitions and racial groups. Understanding these patterns is essential to influence targeted prevention efforts and address disparities. Methods: We extracted national mortality data from the CDC WONDER database for U.S. females from 1999 to 2020 using ICD-10 codes I46 (I46.0, I46.1, I46.9) and R96 ( R96.0, R96.1) to identify SCD cases. Data were stratified by age, menopausal status (pre-menopausal: 25-54; post-menopausal: 55+) and race. Crude death rates were calculated per 100,000 population. Joinpoint regression analysis was used to estimate annual percent changes (APCs) and identify significant changes in trend over time. Results: From 1999 to 2020 a total of 183,360 deaths from SCD in females aged 15-85+ were reported, SCD rates among pre-menopausal women (ages 25-54) increased slightly but significantly (APC +0.51%, 95% CI: 0.07 to 0.99), trend was consistent with no joinpoints identified. In contrast, post-menopausal women (ages 55+) experienced two periods of significant decline: 1999-2005 (APC -7.46%, 95% CI: -9.31 to -6.39) and 2009-2012 (APC -7.62%, 95% CI: -9.21 to -4.77). These were interrupted by non-significant plateaus from 2005-2009 and 2012-2020. To further explore disparities, we conducted a race-stratified Joinpoint analysis which revealed significant declines in SCD rates among post-menopausal Asian/Pacific Islander women across the entire study period (APC -5.47%, 95% CI: -8.51 to -2.16). Among Black women, rates declined significantly from 1999-2015 (APC -3.98%, 95% CI: -4.98 to -3.48) followed by a non-significant increase. White post-menopausal women exhibited multiple significant declines (notably -7.93% from 1999-2005, 95% CI: -10.27 to -6.66, and -7.57% from 2009-2012, 95% CI: -9.41 to -3.96) separated by plateaus. Among pre-menopausal women, SCD rates rose slightly in White women (APC +0.69%, 95% CI: 0.17 to 1.24) but remained stable in Black women. Conclusion: Post-menopausal women carried the highest burden of SCD, however, they experienced the most substantial declines over time. The statistically significant rise in SCD rates among younger pre-menopausal women and the racial disparities in trend patterns highlight the need for renewed prevention strategies tailored to women across age and race groups.