Mortality Trends for Cardiac Arrest with Acute Respiratory Failure Among U.S. Adults: A CDC WONDER Analysis From 1999-2023

ABSTRACT: BACKGROUND: Cardiac arrest(CA) and acute respiratory failure(ARF) are collectively at high risk of causing deaths among adults aged 25 and older in the United States. However, long-term trends to prevent these two coexisting conditions among adults are not well defined. OBJECTIVES: The objective of this study was to analyse mortality trends for CA with ARF among U.S. adults aged 25 years and older from 1999 to 2023. METHODS: Using the CDC WONDER Multiple Cause of Death database, we conducted a retrospective analysis of death certificates listing relevant ICD-10 codes for CA (I46) and ARF (J80, J96) among adults aged 25 years and older. Age-adjusted mortality rates (AAMRs) per 100,000 persons and the annual percentage change (APC) were calculated and stratified by demographics and geography. Trends were assessed using Joinpoint regression to estimate annual percentage change with 95% confidence intervals. RESULTS: From 1999 to 2023, 807,236 deaths were recorded. The overall AAMR showed a significant upward trend (AAPC: 4.06%), rising sharply to a peak in 2021 (28.56) before declining. Males consistently had higher AAMRs than females. Both of them increased till 2021 and later decreased. Racial differences were observed in that Non-Hispanic (NH) Black individuals had the highest average AAMR, while NH Whites had the lowest. Geographically, the Western census region had the highest AAMR, increasing to 37.5 in 2021 (APC: 23.92; 95% CI: 16.21 to 28.35; p=0.0004), and rural areas demonstrated higher mortality than urban areas(13.45 vs 10.53). Adults aged 65 and older showed the highest AAMR, with a sudden rise to 96.7 in 2021 (APC: 17.4; 95% CI: 11.7 to 20.7, p<0.000001), followed by a subsequent decline, compared with the other age groups. CONCLUSIONS: There was a marked AAMR due to CA and ARF over the past 24-year period, with a surge around the COVID-19 pandemic. Significant differences were observed by sex, race, and geography. These findings highlight that efforts are needed to prevent and manage mortalities by interventions among high-risk populations who have both HF and ARF.