Parcha Vibhu, Kalra Rajat, Bhatt Surya P, Berra Lorenzo, Arora Garima, Arora Pankaj
Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL.
Cardiovascular Division, University of Minnesota, Minneapolis, MN.
Chest. 2021 Apr;159(4):1460-1472. doi: 10.1016/j.chest.2020.10.042. Epub 2020 Oct 22.
Despite numerous advances in the understanding of the pathophysiology, progression, and management of acute respiratory failure (ARF) and ARDS, limited contemporary data are available on the mortality burden of ARF and ARDS in the United States.
What are the contemporary trends and geographic variation in ARF and ARDS-related mortality in the United States?
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 through 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 (AAMRs) in the overall population and various demographic subgroups of age, sex, race, urbanization, and region.
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 Black people, and those living in the nonmetropolitan region. The AAMR for ARF-related deaths (per 100,000 people) 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 = .003). The AAMR (per 100,000 people) for ARDS-related deaths was 3.2 (95% CI, 3.2-3.3) in 2014 and 3.0 (95% CI, 3.0-3.1 in 2018; APC, -0.9 [95% CI, -5.4 to 3.8]; P = .56). The observed increase in rates for ARF mortality was consistent across the subgroups of age, sex, race or ethnicity, urbanization status, and geographical region (P < .05 for all). The AAMR (per 100,000 people) for ARF (91.3 [95% CI, 90.8-91.8]) and ARDS-related mortality (3.3 [95% CI, 3.2-3.4]) in 2018 were highest in the South.
The ARF-related mortality increased at approximately 3.4% annually, and ARDS-related mortality showed a lack of decline in the last 5 years. These data contextualize important health information to guide priorities for research, clinical care, and policy, especially during the coronavirus disease 2019 pandemic in the United States.
尽管在急性呼吸衰竭（ARF）和急性呼吸窘迫综合征（ARDS）的病理生理学、进展及管理方面取得了诸多进展，但关于美国ARF和ARDS的死亡负担，目前可得的当代数据有限。
美国ARF和ARDS相关死亡率的当代趋势及地理差异是什么？
对美国国家卫生统计中心的全国死亡率数据进行回顾性分析，以评估2014年至2018年期间ARF和ARDS相关的死亡率趋势，以及2018年所有美国居民中ARF和ARDS相关死亡的地理分布。采用分段线性回归来评估总体人群以及年龄、性别、种族、城市化程度和地区等不同人口亚组的年龄调整死亡率（AAMR）趋势。
在研究期间的1,434,349例ARF相关死亡和52,958例ARDS相关死亡中，AAMR在老年人（≥65岁）、非西班牙裔黑人以及居住在非大都市地区的人群中最高。ARF相关死亡的AAMR（每10万人）从2014年的74.9（95%CI，74.6 - 75.2）增至2018年的85.6（95%CI，85.3 - 85.9）（年百分比变化[APC]，3.4[95%CI，2.2 - 4.6]；P = 0.003）。ARDS相关死亡的AAMR（每10万人）在2014年为3.2（95%CI，3.2 - 3.3），2018年为3.0（95%CI，3.0 - 3.1）；APC为 -0.9（95%CI，-5.4至3.8）；P = 0.56。在年龄、性别、种族或族裔、城市化状态和地理区域等亚组中，观察到的ARF死亡率上升趋势是一致的（所有P < 0.05）。2018年南方地区ARF（91.3[95%CI，90.8 - 91.8]）和ARDS相关死亡的AAMR（每10万人）（3.3[95%CI，3.2 - 3.4]）最高。
ARF相关死亡率每年约上升3.4%，ARDS相关死亡率在过去5年中未呈下降趋势。这些数据提供了重要的健康信息，以指导研究、临床护理和政策的重点方向，尤其是在美国2019年冠状病毒病大流行期间。
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