Abstract WP115: Hormonal Horizons: Stroke Related Mortality Patterns by STRAW Based Reproductive Stage Classification 1999–2023

Introduction: Stroke risk in women changes across reproductive aging due to hormonal influences on vascular health and inflammation. However, limited research has stratified stroke mortality by reproductive stage using standardized criteria. This study applies the STRAW+10 staging system to U.S. mortality data (1999-2023) to identify stage-specific, racial, and geographic disparities and guide prevention strategies. Methods: We extracted female mortality data from CDC WONDER (1999-2023), restricting to cerebrovascular diseases (ICD-10 codes I60-I69) as the underlying cause of death. Females aged 15-84 were classified according to the STRAW +10 staging: 15-39 (reproductive), 40-49 (perimenopause), 50-59 (early menopause), 60-84 (late menopause). Data was further stratified by urban-rural status (2013 NCHS classification), race, and U.S. census region. Crude mortality rates (CMRs) per 100,000 population were calculated. Temporal trends were assessed using Joinpoint regression (5.4.0.0) with Monte Carlo permutation tests on log-transformed values to estimate APC and AAPC. Results: Between 1999 and 2023, 1,095,657 stroke-related deaths occurred in women: 1.54% in reproductive, 3.79% in perimenopausal, 8.15% in early menopausal, and 86.5% in late menopausal. CMRs significantly decreased across all hormonal stages (AAPC for reproductive females: -1.22; 95% CI: -0.96 to -1.53; perimenopausal females: -1.08; 95% CI: -0.79 to-1.34; early menopausal females: -0.92; 95% CI: -0.76 to -1.08; late menopausal female: -2.64; 95% CI: -2.50 to -2.76). Non-Hispanic (NH) Black/African Americans in late menopause had CMRs (183.1) more than four times higher compared to earlier stages, followed by NH Whites (130.7) and Hispanics (97.0). Geographically, late menopausal females in the South had CMRs (146.2) more than six times higher compared to earlier stages, followed by the Midwest (136.7), the West (126.6), and the Northeast (107.2). Additionally, late menopausal females in rural areas had the highest CMR (153.2) compared to urban areas (132.0). Conclusion: Stroke-related mortality in women increases with reproductive aging, particularly in late menopause. Non-Hispanic Black women and females residing in rural areas are subjected to elevated risks. These findings advocate for the inclusion of reproductive aging in stroke risk assessment models and underscore the importance of customizing prevention strategies based on race and geographic location.