Trends and disparities in mortality due to acute respiratory distress syndrome and coexisting sepsis in the United States: a CDC WONDER analysis (1999–2023)

Abstract

Background
Acute respiratory distress syndrome (ARDS) secondary to sepsis remains a life-threatening condition despite advances in critical care. Population-based trends in sepsis-associated ARDS mortality across the U.S. are not well studied. This study examines mortality trends among adults from 1999 to 2023, focusing on demographic and geographic differences.


Methods
This retrospective study utilized the CDC WONDER database as the Source for Multiple Cause of Death. Death certificates were retrieved for Sepsis-related ARDS from 1999 to 2023 among adults ≥25 years. Age-adjusted mortality rates (AAMR) per 100,000 population were calculated, and the annual percentage change (APC) was assessed using Joinpoint regression. Trends were stratified by year, sex, race/ethnicity, and region.


Results
A total of 87,745 deaths were recorded. AAMR declined from 1.92 in 1999 to 1.22 in 2006 (APC = − 6.39%), remained stable through 2018, rose sharply to 3.87 in 2021 (APC = + 42.74%), then fell to 1.30 in 2023 (APC = − 42.70%). Rates were higher in males than in females (AAMR: 1.81 vs. 1.37), with males peaking more steeply during 2018–2021 (APC = + 49.08% vs. + 31.40%), and in older adults (CDR: 4.74). By race, Non-Hispanic (NH) American Indian/Alaska Native had the highest AAMR (2.57), followed by NH Black (2.15) and Hispanic (2.03). Hispanics experienced the steepest pandemic-era spike (6.92 in 2021; APC = + 78.53%), followed by a subsequent decline (APC = − 58.44%). Regionally, the South had the highest mortality (1.77), and nonmetropolitan areas exceeded metropolitan (1.59 vs. 1.45).


Conclusion
Sepsis-associated ARDS mortality declined from 1999 to 2020 but surged during the pandemic before falling again. Persistent disparities by sex, age, race/ethnicity, and geography highlight the need for targeted prevention, earlier detection, and equitable critical care.