Trends in Respiratory Failure Mortality in the United States from 1999 to 2023

Jun Li^1*Yunfei Shu^1,2Suihan Xu¹Biao Zeng¹Zhenyu Yang¹Wei Gao^2*

• ¹Mianyang Central Hospital, Mianyang, China
• ²The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China

Background: The U.S. population is aging, accompanied by concurrent increases in the burden of respiratory failure. However, respiratory failure-related mortality trends among 45 years old adults have not been investigated. The purpose of this study was to assess the trends and regional differences in respiratory failure-related mortality among older adults in the United States. Methods: Data were obtained from the CDC WONDER database, encompassing death records of U.S. residents aged 45 years and older between 1999 and 2023. Cases were identified in which respiratory failure (ICD-10 codes J96.0, J96.1, and J96.9) was documented as the cause of death. We computed both crude and age-adjusted mortality rates (AAMR) per 100,000 population and employed Joinpoint regression to estimate annual percentage changes (APC) and Average Annual Percentage Change (AAPC). Additionally, a sensitivity analysis was conducted in which lung cancer was identified as the underlying cause of death and respiratory failure as a contributing cause, to assess the robustness of the conclusions. Results: A total of 186,075 respiratory failure-related deaths were recorded within the study period. The AAMR increased markedly from 3.71 in 1999 to 10.50 in 2023. The most pronounced upward trend occurred between 2005 and 2018 (APC: +7.96%; 95% CI: 7.44 to 8.93; p <0.001). Specifically, mortality was higher among males than females (AAMR: 11.14 vs. 9.94) in 2023. Racial and ethnic disparities were evident, with non-Hispanic Black or African American individuals exhibiting the highest AAMR (14.07), compared to Hispanic individuals, who showed the lowest (5.96) in 2023. Geographically, rural/county areas experienced a significantly greater AAMR than large and medium/small metropolitan areas (12.27,8.86, and 10.08, respectively) in 2020. Furthermore, distinct mortality trends were observed across various census regions. A sensitivity analysis-where lung cancer was identified as the underlying cause of death and respiratory failure as a contributing cause of death-confirmed this conclusion. Conclusions: respiratory failure-related mortality has risen substantially over the 23-year study period, particularly after 2005, with significant inequalities observed across racial, gender, and geographic subgroups. These findings highlight the urgent need for targeted public health interventions to mitigate the increasing burden of these conditions.