The Burden of Aspiration Pneumonia in Elderly Patients with Neurological Disorders: U.S. Mortality Trends from 1999 to 2020

Introduction:

Background:
Elderly adults (≥65 years) with neurological disorders are at heightened risk of mortality from aspiration pneumonia (AP) in the United States. Despite this, limited data exists on long-term mortality trends for this vulnerable population.

Objective:
To evaluate mortality trends in elderly individuals with AP and underlying neurological conditions, identifying key demographic and geographic disparities.

Methods: Data from the CDC WONDER database was analyzed using ICD-10 codes G00-G98 for neurological disorders as the underlying cause of death and J69 for AP as the contributing cause, from 1999 to 2020. Crude and age-adjusted mortality rates (AAMR) per 100,000 persons, along with 95% confidence intervals (CI), were calculated. Joinpoint regression analysis was applied to estimate annual percentage change (APC) and average annual percentage change (AAPC) in mortality rates.

Results: From 1999 to 2020, there were 168,317 deaths in elderly patients with AP and underlying neurological disorders. A statistically significant decline in AAMR was observed, from 20.2 per 100,000 in 1999 to 15.1 in 2020 (AAPC: -1.5%, 95% CI: -1.7 to -1.2). Males exhibited a higher AAMR (25.7) compared to females (13.6). Non-Hispanic Whites had the highest AAMR (19.4), while non-Hispanic Blacks had the lowest (11.9). Geographically, the Western U.S. had the highest AAMR (22.2), while the Northeast recorded the lowest (14.7). Urban (18.2) and rural (18.7) areas showed similar AAMRs. Among U.S. states, Rhode Island reported the highest AAMR (43.3), and New York the lowest (7.6). Age-specific analysis revealed that individuals over 85 years exhibited the highest crude mortality rate (67.5).

Conclusion : This study highlights a significant decline in mortality among elderly patients with AP and neurological disorders over the past two decades, while also revealing substantial disparities across gender, race, and geographic regions. These findings underscore the need for targeted interventions and healthcare policies to address these disparities and improve outcomes in this high-risk population.