Cardiometabolic deaths in premenopausal black and white women.

Background: 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. Methods: 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). Results: 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. Conclusions: 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.