Trends in Aspiration Pneumonia and Dysphagia Related Mortality Among Older Adults in the United States: A Retrospective Analysis From 1999 to 2022

Abstract Rationale:Dysphagia increases the risk of aspiration pneumonia with resultant morbidity and recurrent hospital admissions. It is reported that over 90% of community-acquired pneumonia in older adults may be due to aspiration. This study aimed to investigate aspiration pneumonia mortality rates in older adults with dysphagia in the United States (US). Methods:We analyzed the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) for death certificates (1999-2022) of adults 65 years and older with aspiration pneumonia and dysphagia using the ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th revision) codes, J69 (aspiration pneumonia) and R13 (dysphagia). Crude mortality rates (CMR), age-adjusted mortality rates (AAMR) per 1,000,000, and annual percent change (APC) with a 95% confidence interval (CI) were calculated through Joinpoint regression. Results:From 1999 to 2022, a total of 185,694 deaths attributed to aspiration pneumonia and dysphagia were reported among older adults in the US, with an overall AAMR of 17.79. The AAMR increased from 13.4 in 1999 to 19.5 in 2022, a 1.5-fold increase. A gradual increasing trend in mortality was observed from 1999 to 2005 (APC 4.1[asterisk], 95% CI = 2.21 to 8.11), followed by a period of decline until 2009 (APC -2.41, 95% CI = -6.39 to 1.22). However, the AAMR rose after that till 2022 with a significant increase from 2009 to 2015 (APC 3.46[asterisk], 95% CI = 1.36 to 8.45). The AAMR in males (25.77) was twice as much as females (12.89). The highest CMR was observed in individuals older than 85 (76.07), followed by those aged 75 to 84 (18.14). Non-Hispanic (NH) Whites showed the highest AAMR (18.23), followed by NH American Indians or Alaskan Natives (17.82), NH Asians or Pacific Islanders (17.63), Hispanics (15.48), and NH Black or African Americans (14.9). We also observed variations in AAMRs across different census regions (West: 20.17, South: 19.19, Midwest: 17.04, and Northeast: 13.75). From 1999 to 2020 urban areas had higher AAMRs (18.4) than rural areas (15.26). Conclusion:An overall increasing trend of aspiration pneumonia-related deaths was observed among older adults with dysphagia in the US. The highest mortality was seen among NH Whites, males older than 85, and residents of the Western US. The results of our study highlight the need for early detection and intervention of dysphagia in elderly patients to reduce the aspiration pneumonia mortality burden in this population.