Temporal trends in mortality associated with chronic lower respiratory disease and dementia: evidence from CDC WONDER, 1999–2023

Abstract

Chronic lower respiratory disease (CLRD) and dementia are the leading causes of death among older US adults and frequently coexist; however, their combined mortality burden is uncharacterized nationally. We examined the trends and disparities in deaths involving both. We analyzed 1999–2023 US multiple cause-of-death data from the CDC WONDER for decedents aged ≥ 65 years with both CLRD (ICD-10 J40–J47) and dementia (F01, F03, G30–G31) listed anywhere on the certificate. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated overall and by sex, race/ethnicity, census region, urbanization, and place of death; crude rates (CMRs) were used for age strata. Joinpoint regression gave annual and average annual percent changes (APCs, AAPCs). Among 557,547 deaths, the overall AAMR rose from 29.50 per 100,000 in 1999 to 55.69 in 2023, peaking at 65.70 in 2020 (AAPC: 2.64; 95% CI: 0.93–4.39; p  = 0.002). Men had a higher mean AAMR than women (57.58 vs. 47.29), but only women rose significantly (AAPC: 3.66; p  < 0.001 vs. 1.42; p  = 0.128); the male-to-female ratio fell from 1.62 to 0.97, with women overtaking men by 2023. The mean AAMRs were 55.07 in non-Hispanic (NH) White (AAPC: 3.02; p  = 0.0004), 40.56 in NH Black (2.70; p  = 0.035), 32.47 in Hispanic (1.20; p  = 0.001), and 20.42 in NH Asian or Pacific Islander adults (3.13; p  = 0.206); and 55.18 in the South (2.80; p  < 0.001), 54.84 in the Midwest (3.02; p  = 0.004), 51.19 in the West (2.53; p  = 0.005), and 39.60 in the Northeast (1.91; p  = 0.065). Non-metropolitan AAMRs exceeded metropolitan AAMRs (61.70 vs. 47.61; AAPC: 4.12; p  < 0.001 vs. 2.85; p  = 0.008), with the gap widening from 5.0 to 22.6. 2023 CMRs were 243.83 (≥ 85 years; AAPC: 3.19; p  = 0.001), 59.36 (75–84; 2.38; p  = 0.011) and 8.98 (65–74; 2.80; p  = 0.019). Nursing home deaths fell from 58.2% to 43.3% as home deaths rose to 28.0% and hospice deaths to 7.9%. Mortality involving coexisting CLRD and dementia in older US adults nearly doubled from 1999 to 2023, shifting toward women, non-metropolitan residents, and the very old, while end-of-life care moved from hospitals and nursing homes into homes and hospices.