Abstract TP176: Temporal Trends in Stroke Mortality by Sex in Postmenopausal Women (55-75 Years) in the United States: A CDC Wonder Analysis (1999-2020)

Background: Stroke is a leading cause of death and disability worldwide, with 6.6 million deaths and 143 million DALYs in 2019. Women experience strokes at older ages than men but face worse outcomes and higher mortality, especially in the postmenopausal period (55–75 years). Hormonal decline during menopause increases vascular risk, while disparities in recognition and care worsen outcomes. Hormone therapy may also elevate ischemic stroke risk. Racial and ethnic disparities persist, with non-Hispanic African American women having the highest mortality. Using CDC WONDER data, this study examined temporal trends and sex-based differences in stroke mortality among U.S. adults aged 55–75 years from 1999–2020 to identify disparities and guide prevention. Methods: A population-based analysis was conducted using CDC WONDER Multiple Cause-of-Death data (1999–2020) for postmenopausal women (55–75 years; ICD-10 I63). Age-adjusted and crude mortality rates (AAMRs, CMRs) per 100,000 were calculated using the 2000 U.S. standard population. Data were stratified by race/ethnicity, census region, state, and urbanization (2013 NCHS classification). Joinpoint regression assessed trends with annual percent change (APC) and average annual percent change (AAPC); significance was set at p<0.05. Results: From 1999–2020, 46,442 stroke-related deaths occurred in postmenopausal women, with an AAMR of 7.12 (95% CI: 7.05–7.18) per 100,000. Mortality declined significantly from 1999–2009 (APC −8.90%, 95% CI: −9.66 to −8.13) but rose sharply from 2014–2018 (APC 24.71%, 95% CI: 18.89–30.82). Disparities were evident: highest AAMR among non-Hispanic Black women (12.17), followed by NH Whites (6.63) and Hispanics (5.79), with the lowest in Asians/Pacific Islanders (4.83). Regionally, the South had the highest AAMR (8.08) and the Northeast the lowest (5.46). Rural areas had higher rates (8.12) than urban areas (6.87). Conclusion: Persistent sex- and race-based disparities in stroke mortality exist among U.S. adults aged 55–75 years. Estrogen deficiency accelerates atherosclerosis, endothelial dysfunction, and prothrombotic states, heightening cerebrovascular risk. Recognition of these mechanisms underscores the need for tailored prevention, early detection, and equitable access to care. Focused efforts are essential to reduce avoidable deaths and improve outcomes in postmenopausal women, a group historically underrepresented in stroke research.