Abstract DP209: Disproportionate Reversal of Ischemic Stroke Mortality Decline in U.S. Postmenopausal Women Compared with the General Population, 1999–2023

Background: Ischemic stroke (IS) is a leading cause of death in U.S. women. Mortality declined in the early 2000s but recent evidence suggests a disproportionate reversal. Postmenopausal (PM) women face unique vascular risks, yet national trends in this group remain underexplored. We examined ischemic stroke mortality by race/ethnicity and age. Methods: We analyzed IS deaths in U.S. women aged ≥55 years (proxy for PM) from 1999–2023 using CDC WONDER multiple cause-of-death data (ICD-10 I63). Age-adjusted mortality rates (AAMR) per 100,000 were calculated with the 2000 U.S. standard population. Temporal trends were assessed with Joinpoint regression, reporting annual percent change (APC) with 95% confidence intervals (CI), with significance set at p<0.05. Analyses were stratified by overall, race/ethnicity, and 10-year age group. Sensitivity analysis compared overall U.S. ischemic stroke mortality. Results: A total of 307,491 IS deaths occurred in women ≥55 years. The AAMR in PM women was 44.1 per 100,000 in 1999 and 47.0 in 2023. In contrast, the overall population rose from 10.5 to 17.7, showing a similar biphasic pattern but with lower absolute rates. Among PM women, mortality declined steadily to 14.2 in 2014, then doubled from 2014–2017 (APC +30.79%, p<0.05) and continued increasing through 2023 (APC +8.71%, p<0.001), returning to baseline 1999 levels. Racial disparities were marked, with AAPC ranging from –0.36% in Asian/Pacific Islander women to +1.23% in Hispanic/Latino women. From 2014 onward, sharp rises were observed in Hispanic/Latino (10.0 to 39.3), Black (16.0 to 62.0), American Indian/Alaska Native (13.0 to 37.7), and White (14.5 to 47.2) women, widening gaps between populations. Regionally, overall changes were modest (AAPCs: –0.48% Northeast, +0.31% Midwest, +1.15% South, +0.10% West), yet all showed early declines followed by renewed increases. Mortality rose most steeply with age, particularly in women ≥85 years, who returned to 1999 levels by 2023. Inpatient settings accounted for 42% of deaths. Conclusion: IS mortality in U.S. PM women has reversed long-term declines since the mid-2010s, rising back to AAMR 47 compared with 18 in the overall population. This reflects a disproportionate burden in PM women, most pronounced among Hispanic/Latino, Black, and American Indian/Alaska Native women and the oldest age groups. These findings underscore the urgent need for targeted prevention, aggressive risk-factor control, and equitable stroke care.