Demographic and regional disparities in concurrent respiratory and renal failure mortality: a CDC WONDER analysis, 1999–2024

Concurrent respiratory and renal failure carries exceptionally high mortality, yet population-level trends remain understudied. We analyzed temporal trends and demographic disparities in US mortality for this dual-organ failure from 1999 to 2024. We analyzed mortality data via CDC WONDER for deaths citing both respiratory (J96) and renal failure (N17-N19). Age-adjusted mortality rates (AAMRs) per 100,000 persons were extracted. Temporal trends were assessed using Joinpoint regression to estimate the Annual Percent Change (APC) with 95% confidence intervals (CIs). From 1999 to 2024, 894,269 US deaths involved concurrent respiratory and renal failure. AAMR increased from 5.76 to 14.01 per 100,000 population, rising from 1999 to 2011 (APC: 3.96), remaining stable during 2011-2018 (APC: -0.10; P = 0.90), sharply increasing during 2018-2021 (APC: 25.36), and declining from 2021 to 2024 (APC: -8.17). AAMR nearly doubled during 2020-2022 compared with 1999-2019 (16.37 vs. 8.06). Mortality was higher in men (12.01 vs. 7.66), non-Hispanic Blacks (15.42), and in the South and West, with non-metropolitan rates surpassing metropolitan areas in later years. Mortality from concurrent respiratory and renal failure more than doubled in the U.S. over the past two decades, with substantial disparities by sex, race/ethnicity, and geography. The sharp pandemic-era increase and persistent socio-regional inequities underscore a growing public health burden that warrants focused clinical attention and resource allocation.