Abstract TP131: Heightened Burden of Haemorrhagic Stroke Mortality in Postmenopausal Women Compared with the U.S. Population, 1999–2023

Background: Haemorrhagic stroke (HS) is a major cause of mortality in post-menopausal women (PM), who face heightened risk due to vascular aging. While overall stroke mortality has declined, recent data show slowing progress and persistent racial and regional disparities, necessitating reassessment of long-term trends. Methods: We analysed U.S. mortality data (1999–2023) from CDC WONDER for women aged ≥55 years (PM). HS deaths were identified using ICD-10 code I61. Age-adjusted (AAMR) and crude mortality rates (CMR) were calculated, stratified by race/ethnicity, region, and place of death. Trends were assessed with Joinpoint regression, reporting APC, AAPC, 95% CI, significance at p<0.05. Sensitivity analysis used overall U.S. adult HS mortality for comparison. Results: Overall PM AAMR declined (AAPC = -2.16%*), from 36.5 (1999) to 21.2 (2023). Two phases emerged: rapid decline (APC = -3.43%*) from 1999–2012, then slower decline (APC = -0.63%*) from 2012–2023. Sensitivity analysis showed overall mortality declined from 10.1 to 6.3 (AAPC = -1.90*), with early reductions (APC = -3.49%*) and stabilization post 2012 (APC = 0.12%), confirming similar plateauing trends and highlighting that PM women remain disproportionately affected. All racial groups declined significantly. American Indian/Alaska Natives (-2.15%*), Asian/Pacific Islanders (-3.20%*) and Hispanics (-2.13%*) had steep early declines that flattened after 2012, Whites (-2.20%*) showed strong early reductions with slower declines after 2011, and non-Hispanic Black women had highest rates (42.4→26.0) with slowest decline (-1.99%*). Mortality decreased across all ages (55–64, 65–74, 75–84, 85+) but spiked in 2020/2021, most in oldest cohorts. All census regions declined (AAPCs: -2.35%* Northeast, -1.92%* Midwest, -2.24%* South, -2.27%* West), with early reductions slowing after 2010–2012. Most deaths occurred in inpatient facilities (75%) Conclusions: HS mortality in PM women fell substantially since 1999, with trends similar to overall adult mortality but slowed after 2012. Trends in postmenopausal women mirror the general population but at higher mortality, underscoring heightened burden. Non-Hispanic Black women remain most affected, with highest rates and slowest decline, and regional disparities persist. Surges in 2020–2021, especially in oldest women, underscore fragile gains. Equity-focused, targeted public health strategies are urgently needed to address disparities and sustain prevention.