Trends and Geographic Variation in Acute Respiratory Failure and ARDS Mortality in the United States

Abstract

Background Despite numerous advances in the understanding of the pathophysiology, progression, and management of acute respiratory failure (ARF) and acute respiratory distress syndrome (ARDS), there is limited contemporary data on the mortality burden of ARF and ARDS in the United States (US). Research Question What are the contemporary trends and geographic variation in ARF and ARDS-related mortality in the US? Study Design and Methods A retrospective analysis of the National Center for Health ”Statistics’ nationwide mortality data was conducted to assess the ARF and ARDS-related mortality trends from 2014-2018 and the geographic distribution of ARF and ARDS-related deaths in 2018 for all American residents. Piecewise linear regression was used to evaluate the trends in age-adjusted mortality rates (AAMR) in the overall population and various demographic subgroups of age, sex, race, urbanization, and region. Results Among 1,434,349 ARF-related deaths and 52,958 ARDS-related deaths during the study period, the AAMR was highest in older individuals (≥65 years), non-Hispanic Blacks, those living in the non-metropolitan region. The AAMR for ARF-related deaths (per 100,000 persons) increased from 74.9 (95%CI:74.6-75.2) in 2014 to 85.6 (95%CI:85.3-85.9) in 2018 (Annual Percentage Change [APC]: 3.4 [95%CI:2.2-4.6];P trend =0.003). The AAMR (per 100,000) for ARDS-related deaths was 3.2 (95%CI:3.2-3.3) in 2014 and 3.0 (95%CI:3.0-3.1) (APC: -0.9 [95%CI:-5.4-3.8]; P trend =0.56). The observed increase in rates for ARF mortality was consistent across the subgroups of age, sex, race/ethnicity, urbanization status, and geographical region (P trend <0.05 for all). The AAMR (per 100,000 persons) for ARF (91.3 [95%CI: 90.8-91.8]) and ARDS-related mortality (3.3 [95%CI:32.34]) in 2018 were highest in the South. Interpretation The ARF-related mortality increased at ∼3.4% annually, and ARDS-related mortality showed a lack of decline in the last five years. These data contextualize important health information to guide priorities for research, clinical care, and policy, especially during the coronavirus disease-19 pandemic in the US.

Association between lactate/albumin ratio and all-cause mortality in patients with acute respiratory failure: A retrospective analysis

“…More than 50% of critically ill patients in the intensive care unit (ICU) will suffer from acute respiratory failure (ARF) due to respiratory diseases or pulmonary vascular diseases, accompanied by pulmonary ventilation and/or ventilation dysfunction [1][2][3]. ARF can cause metabolic disorders and accelerate the deterioration of the underlying condition, which is related to a mortality rate of 35%-46% [4]. Therefore, effective assessment of the prognosis of patients with ARF is of great significance for clinically formulating treatment strategies and improving the survival rate of patients [5].…”

Coronary artery bypass graft surgery outcomes in the United States: Impact of the coronavirus disease 2019 (COVID-19) pandemic

“…[11][12][13] While the reassuring findings are encouraging, continued comprehensive COVID-19 infection control protocol implementation and COVID-19 screening of patients and health care personnel and proactive management of coronary artery disease patients is needed. [12][13][14][15][16][17][18][19][20][21] Our data do not provide information regarding the COVID-19 infection rates among health care workers taking care of patients who underwent CABG. Given that very few patients were diagnosed with COVID-19 in the postoperative period highlights the effectiveness of preoperative screening and strict infection control measures.…”

“…The primary study outcome was mortality occurring within 30 days of CABG. The secondary outcomes assessed included stroke (ICD-10: I60-I69), acute kidney injury (ICD-10: N17), acute respiratory distress syndrome (ICD-10 Code: J80), 14 and mechanical ventilation (ICD-10 codes: 5A1945Z, 5A1955Z, 39.65; Current Procedural Terminology codes: 1022227, 31500, 0BH17EZ, 0BH18EZ) occurring within 30 days of CABG. Table E2 enlists the diagnosis codes for the various measures and outcomes.…”

Inhaled Prostacyclin Improves Oxygenation in Patients with COVID-19-induced Acute Respiratory Distress Syndrome

“…Third, the intervention group and the control group differed significantly in age, which could have a potential effect on the overall outcome in this patient group. The average age was older in the intervention group, and therefore, one would expect this factor to have a potential negative effect if any effect at all, based on the literature (21, 22). However, in our sample, no significant association of age with the primary outcome was observed.…”