Trends and mortality due to acute respiratory distress syndrome in the United States (1999–2023): A 25-year nationwide study

Acute respiratory distress syndrome (ARDS) remains a significant cause of morbidity and mortality in the United States. Although advances in critical care have improved outcomes, the Coronavirus Disease of 2019 (COVID-19) pandemic substantially altered ARDS epidemiology, necessitating updated analyses of national mortality trends. To examine 25-year trends (1999-2023) in ARDS-related mortality across demographic, geographic, and urbanization categories, and to evaluate the impact of the COVID-19 pandemic on these patterns. We conducted a population-based descriptive study using CDC WONDER multiple cause-of-death data. ARDS-related deaths were identified by ICD-10 code J80. Crude and age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Temporal changes were analyzed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals. Mortality rates were stratified by sex, age, race/ethnicity, census region, state, and urban-rural classification. Between 1999 and 2023, 364,924 ARDS-related deaths were recorded. National AAMRs declined steadily from 1999 to 2018 (APC -2.63; 95% confidence interval (CI): -4.74--1.04), surged sharply during 2018 to 2021 (APC 85.78; 95% CI: 53.65-109.16), and decreased between 2021 and 2023 (APC -59.59; 95% CI: -68.58--47.89), resulting in an overall AAPC of -1.90 (95% CI: -3.80-0.19). Males consistently exhibited higher mortality rates than females. Individuals aged ≥ 75 years had the highest AAMRs. Non-Hispanic Black, Hispanic/Latino, and American Indian/Alaska Native populations experienced disproportionately elevated mortality. Rural areas and the South and Midwest regions showed greater increases during the pandemic. California, Texas, Florida, and New York reported the highest cumulative death counts. ARDS mortality in the United States declined for nearly 2 decades but rose sharply during the COVID-19 pandemic, highlighting persistent disparities by age, sex, race, geography, and urbanization. Targeted interventions and equitable critical care access are essential to reduce future ARDS-related deaths. Detailed Visual Abstract is illustrated in the Central Illustration.