Emerging age, sex, ethnoracial, and regional trends in pneumonia and influenza-related mortality among children from 1999 to 2020

Deaths related to pneumonia and influenza have been consistently declining overall in the United States (US). However, pneumonia remains one of the highest causes for morbidity and mortality, demographic and regional trends and disparities in pneumonia and influenza-related mortality must be comprehensively studied. This study analyzed mortality data extracted from the CDC WONDER database from 1999 to 2020 for children under 5 years of age. Crude mortality rates (CMRs) were calculated and Joinpoint regression analysis was used to identify trends based on annual percentage changes (APCs) values. A total of 17,229 pneumonia and influenza-related deaths occurred among children < 5 years between 1999 and 2020 (CMR: 3.3; 95% CI: 3.2-3.3). CMRs were consistently higher in male children (CMR: 3.5; 95% CI: 3.5-3.6) and among Black Americans (CMR: 5.8; 95% CI: 5.6-6.0), while lowest in Asian/Pacific Islanders (CMR: 2.4; 95% CI: 2.2-2.6). Among states, CMRs were highest in Alaska (CMR 6.9; 95% CI: 5.6-8.5). Nonmetropolitan areas had comparatively higher CMRs (CMR: 4; 95% CI: 2.9-3). A consistent decline was found in pneumonia and influenza-related mortality in children < 5 years old. Targeted strategies addressing the existing disparities can help optimize health outcomes and improve survival rates in populations at risk.