Abstract Body (Do not enter title and authors here): Background
Non-Ischemic Cardiomyopathy accounts for significant portion of cardiomyopathy with prevalence of about 15% in the community. Non-Ischemic cardiomyopathy (NICM) is a common cause of mortality, especially among older adults. We explored the sex, racial, and geographic trends in the mortality among Older Adults with Non-Ischemic Cardiomyopathy (NICM) in the US from 1999 to 2020

Methods
We performed a retrospective analysis of the national death certificate data from the CDC’s wonder database. We included persons ≥65 years of age with non-ischemic cardiomyopathy (ICD -10 code I42) as the underlying cause of death. The exposure variable was the year of death, and the outcome was NICM age-adjusted mortality rate (AAMR) stratified by sex, race, rural-urban, and census region. We calculated the NICM AAMR per 100,000. Trends were evaluated with Joinpoint regression and expressed as an average annual percentage change (AAPC) with a 95% confidence interval (CI). P<0.05 defined statistical significance.

Results
Out of 4.4 billion people, 358,645 deaths occurred from NICM (AAMR 38.9). The AAMR was higher in males (53.4 vs 29.1 in females; P < 0.000001), Blacks (54.9 vs 38.1 in White; P < 0.000001), American Indian (25.1 vs 20.0 in Asian Pacific ; P< 0.000001), Urban (39.6 vs 37.0 in rural P < 0.000001) , Southern region (42.1 vs 40.5 Midwest; P<0.000001) and Northeast (37.1 vs 33.6 in West P<0.000001). The overall AAMR reduced from 54.4 to 25.1 (AAPC -3.0%; CI: -3.2, -2.4). Furthermore, the AAMR decreased significantly in males (AAPC -3.3%; CI: -4.4, -1.7) and females (AAPC -2.8%, CI: -3.3, -1.4). Similarly, it decreased in Blacks (AAPC -5.4%, CI: -8.4, -4.0), White (AAPC -2.9%, CI:-3.2, -2.4), Asian Pacific (AAPC -4.6%, CI:-5.2, -4.0 ), American Indian ( AAPC -4.3%, CI: -5.3,-3.2), rural (AAPC -2.6%, CI: -2.8,-2.3), urban(AAPC -2.6%, CI: -2.7, -2.5) and across all geographic regions.

Conclusion
Non-Ischemic Cardiomyopathy mortality has decreased over the last two decades among older adults in the US. Even though Non-ischemic cardiomyopathy mortality has decreased significantly in the last two decades among older adults in the US, there are significant racial disparities, especially between Black and white racial groups. These findings warrant further studies to determine the cause of these disparities and provide solutions to mitigate them.