Nationwide trends in pneumonia-associated mortality and the impact of the COVID-19 pandemic

Pneumonia-related mortality in the United States has shown a notable decline. However, epidemiological analyses of the COVID-19 pandemic's impact on these trends are limited. We evaluated pneumonia mortality trends pre-and-post the pandemic. Age-adjusted mortality rates (AAMR) per 100,000 were obtained from the CDC WONDER database through ICD-10 codes. Data were stratified based on sex, region, and state. Temporal trends were assessed with average annual percentage changes (AAPC). A total of 3.54% of all deaths (<i>n</i> = 2,360,261) between 1999 and 2023 were due to pneumonia. Males exhibited a 1.3-fold higher AAMR compared to females (AAMR: 20.4 vs 15.3; <i>p</i> = 0.003). However, pneumonia accounted for a greater proportion of all-cause mortality among females than males (2.42% vs 2.06%). Overall, a significant decline in mortality was observed from 1999 to 2018, followed by a sharp rise. No significant AAMR trends were noted over the full study period (AAPC -0.32%; <i>p</i> = 0.81), but excluding COVID-19 deaths revealed a significant decline (AAPC -3.41%; <i>p</i> < 0.005). Marked geographic disparities were observed, with the highest median AAMR in Arkansas (24.9, IQR 6.8) and the lowest in Florida (9.4, IQR 6.3). The East South-Central region exhibited significantly higher pneumonia mortality rates (<i>p</i> < 0.001). The pre-existing declining trend of pneumonia associated mortality was markedly affected by the COVID-19 pandemic. Our findings underscore the need for tailored public health interventions and further research into demographic and geographic factors influencing pneumonia outcomes.