Long-term mortality trends of COPD and respiratory failure among adults aged ≥25 years in the United States: an analysis of CDC WONDER data (1999–2023)

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States and frequently associated with advanced stages complicated by respiratory failure (RF), a major terminal event that has been epidemiologically associated with significantly higher mortality risk among COPD patients. Despite this, long-term population-level trends in COPD-related mortality complicated by RF remain insufficiently characterized.

We aimed to quantify long-term mortality trends of COPD and RF among adults aged 25 years or older in the United States from 1999 to 2023 by analyzing age-adjusted mortality rates (AAMRs), annual percent changes (APCs), and demographic and geographic variations using the CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database.

Using national multiple-cause-of-death data from 1999 to 2023, we identified deaths in which COPD and respiratory failure were co-listed using ICD-10 codes. Mortality trends were assessed using Joinpoint regression analysis to estimate APC, along with 95% confidence intervals (CIs) and statistical significance testing ( P < 0.05). AAMRs were calculated per 100 000 population using the direct standardization method based on the 2000 U.S. standard population. CDC WONDER is a publicly available, population-based mortality database maintained by the Centers for Disease Control and Prevention, which provides de-identified national death certificate data.

A total of 1 393 458 adults aged 25 years or older died from COPD and RF between 1999 and 2023. The overall AAMR was 24.9 per 100 000 (95% CI: 24.8–24.9) with a significant increasing trend (APC: 0.88%, 95% CI: 0.41–1.38, P < 0.0008). Men had higher mortality than women (29.1 vs 22.1 per 100 000), while women showed a faster increase (APC: 1.27% vs 0.29%). White adults had the highest mortality rate (26.3 per 100 000), while Asian or Pacific Islanders had the lowest (8.7 per 100 000). The Midwest showed the steepest rising trend (APC: 2.25%, P < 0.000001), while other regions showed lower or non-significant changes. West Virginia had the highest state-level mortality, and Hawaii the lowest.

Targeted public health strategies focusing on smoking cessation, early screening of high-risk populations, improved access to pulmonary care, and reduction of regional healthcare disparities may help address factors associated with COPD- and respiratory failure–related mortality in the United States. These findings represent population-level associations and should not be interpreted as causal relationships.