Abstract Body (Do not enter title and authors here): Background: Black women in the United States experience a disproportionate burden of cardiometabolic disease (CMD) beginning in adolescence, although CMD mortality is often thought to emerge at menopause.

Objectives: 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 standard 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% (1 in 111) for Black women and 0.33% (1 in 306) for White women (risk ratio: 2.73, 95% CI: 2.59–2.87). Of the 2,716 expected CMD deaths in the Black cohort, 1,726 (63.6%) were excess deaths. CMD accounted for 20.1% of deaths in Black women (rising from 7.8% at age 25 to 27.6% at age 44) versus 10.7% in White women (6.0% to 15.6%). Average YLL was 4.42 months for Black women and 1.70 months 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.