Mortality trends of aspiration-associated respiratory failure in the united states : a multiple cause of death analysis

Aspiration-associated respiratory failure is an important but under-recognized cause of morbidity and mortality among U.S. adults. Despite its clinical significance, national epidemiologic patterns and demographic disparities remain poorly characterized. Mortality data from the CDC WONDER Database (1999–2023) were extracted for adults aged ≥ 25 years in the U.S. with Aspiration and Respiratory Failure listed as underlying or contributing causes of death. Age-adjusted mortality rates (AAMRs) were calculated. Joinpoint regression was used to estimate the Annual Percent Change (APC) and Annual Average Percentage Change (AAPC) with 95% confidence intervals (CIs). Between 1999 and 2023, 372,764 deaths involving aspiration-associated respiratory failure were identified among U.S. adults aged ≥ 25 years. The age-adjusted mortality rate increased from 4.27 to 10.17 per 100,000 population (AAPC: 3.98%; p < 0.001). Males had higher mean AAMRs than females (8.94 vs. 4.72 per 100,000). Adults aged ≥ 65 years had the highest crude mortality rate (27.79 per 100,000). Non-Hispanic African Americans (7.10) and American Indian/Alaska Native populations (6.61) had the highest mean AAMRs, while metropolitan areas had slightly higher AAMRs than non-metropolitan areas (5.99 vs. 5.40). Mortality involving aspiration-associated respiratory failure increased significantly from 1999 to 2023, with substantial demographic and geographic disparities. These findings support improved dysphagia prevention, surveillance, and targeted public health interventions.