# Cardiometabolic deaths in premenopausal black and white women

## TL;DR

Black women in the U.S. face a significantly higher risk of cardiometabolic deaths before menopause compared to White women, highlighting the need for earlier interventions.

## Contribution

This study provides the first detailed comparison of cardiometabolic mortality risks in premenopausal Black and White women using life table methods.

## Key findings

- Black women aged 25 have a 0.90% cumulative CMD mortality risk by age 45, compared to 0.33% in White women.
- 63.89% of CMD deaths in younger Black women are excess deaths relative to White women.
- CMD accounts for 20.13% of deaths in Black women aged 25-44, compared to 10.73% in White women.

## Abstract

•Cardiometabolic disease (CMD) mortality risk in premenopausal women is often overlooked.•Period life tables provide reliable estimates of age-specific CMD mortality risk.•One in 111 Black women aged 25 years is expected to die from CMD by age 45.•One in 306 White women aged 25 years is expected to die from CMD by age 45.•Six in ten CMD deaths of younger Black women were excess deaths relative to White women.

Cardiometabolic disease (CMD) mortality risk in premenopausal women is often overlooked.

Period life tables provide reliable estimates of age-specific CMD mortality risk.

One in 111 Black women aged 25 years is expected to die from CMD by age 45.

One in 306 White women aged 25 years is expected to die from CMD by age 45.

Six in ten CMD deaths of younger Black women were excess deaths relative to White women.

Black women in the United States bear a disproportionate burden of cardiometabolic disease (CMD) beginning in adolescence, while CMD mortality is often thought to emerge at menopause. This study estimates and compares CMD mortality risks in Black and White women aged 25-44 years.

Using National Vital Statistics System data and life table methods, we estimated CMD mortality risk in hypothetical cohorts of non-Hispanic Black and White women aged 25-44, with cohort sizes matched to the 2022 U.S. population. We estimated cumulative risk and quantified excess mortality, proportional mortality, and years of life lost (YLL).

The cumulative CMD mortality was 0.90 % (95 % CI: 0.86 % to 0.93 %) for Black women and 0.33 % (95 % CI: 0.32 % to 0.34 %) for White women (risk ratio: 2.74, 95 % CI: 2.64 to 2.85). Of the 2,716 expected CMD deaths in the Black cohort, 1,735 or 63.89 % (95 % CI: 62.53 % to 65.24 %) were excess deaths. CMD accounted for 20.13 % (95 % CI: 19.45 % to 20.80 %) of deaths in Black women (rising from 7.8 % at age 25 to 27.6 % at age 44) versus 10.73 % (95 % CI: 10.40 % to 11.06 %) in White women (rising from 6.0 % to 15.6 %). Average YLL was 4.42 months (95 % CI: 4.40 to 4.44) for Black women and 1.70 months (95 % CI: 1.69 to 1.71) for White women.

CMD mortality was higher in younger Black than White women and emerged well before menopause. Reducing these disparities requires earlier screening, improved healthcare access, and structural reforms.