1999-2024年美国成人中吸入性肺炎作为根本死因并合并卒中的死亡率趋势与差异：一项CDC WONDER分析
Trends and Disparities in Aspiration Pneumonitis Mortality With Co-Listed Stroke Among US Adults, 1999-2024: A CDC WONDER Analysis.
文献信息
| PMID | 42740601 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Mirza Ammar Arshad |
| 作者单位 | Department of Medicine, Rahbar Medical and Dental College, Lahore, Pakistan. |
| 期刊 | Brain and behavior |
| SCI 分区 | Q2 |
| IF | 3.2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 吸入性肺炎是卒中后严重的呼吸系统并发症，然而在美国，以吸入性肺炎为根本死因并合并卒中的当代死亡率趋势仍不明确。我们评估了1999年至2024年美国25岁及以上成人中吸入性肺炎合并卒中的全国死亡率趋势及差异。
方法： 我们对CDC WONDER多死因数据进行了1999年至2024年的回顾性、基于人群的连续横断面分析。当吸入性肺炎（ICD-10 J69.0）为根本死因且卒中（I60-I69）为促发死因，且死者为25岁及以上成人时，纳入该死亡病例。每10万人口的年龄调整死亡率（AAMR）按2000年美国人口进行标准化；年龄别死亡率为粗率。采用Joinpoint回归估计年度百分比变化（APC）和平均年度百分比变化（AAPC）。
结果： 共识别出296,691例死亡。总体AAMR从1999年的9.20下降至2024年的3.55（AAPC，-3.66%；95% CI，-4.34至-2.97，p < 0.001）。男性死亡率从13.38下降至4.92（AAPC，-3.85%），女性从6.79下降至2.46（AAPC，-3.92%；两者p < 0.001）。所有人口普查地区死亡率均下降，包括东北部（AAPC，-3.98%；p < 0.001）、中西部（AAPC，-3.76%；p < 0.001）、南部（AAPC，-3.93%；p < 0.001）和西部（AAPC，-3.57%；p < 0.001），其中2024年南部AAMR较高（3.88）。非大都市县的死亡率仍较高，AAMR从1999年的9.96下降至2020年的4.42（AAPC，-4.05%；p < 0.001），而大都市县的AAMR从9.02下降至3.80（AAPC，-4.31%；p < 0.001）。在非西班牙裔黑人成人中，2014-2024年趋势保持稳定（APC，1.13%；p = 0.12）。2010年后，35-44岁（APC，6.65%；p < 0.001）、45-54岁（APC，4.70%；p < 0.001）和55-64岁（APC，3.96%；p < 0.001）成人的死亡率上升。
结论： 合并卒中的吸入性肺炎死亡率在全国范围内下降，但进展不均衡，仍存在持续的人口学、地区和城乡差异。
英文摘要
BACKGROUND: Aspiration pneumonitis is a serious poststroke respiratory complication, yet contemporary US mortality trends involving aspiration pneumonitis as the underlying cause of death with co-listed stroke remain unclear. We evaluated national trends and disparities in aspiration pneumonitis mortality with co-listed stroke among US adults aged ≥ 25 years from 1999 to 2024.
METHODS: We conducted a retrospective, population-based serial cross-sectional analysis of CDC WONDER multiple cause of death data from 1999 through 2024. Deaths were included when aspiration pneumonitis (ICD-10 J69.0) was the underlying cause and stroke (I60-I69) was a contributing cause among adults aged ≥ 25 years. Age-adjusted mortality rates (AAMRs) per 100,000 population were standardized to the 2000 US population; age-specific rates were crude. Joinpoint regression estimated annual percent changes (APCs) and average annual percent changes (AAPCs).
RESULTS: A total of 296,691 deaths were identified. The overall AAMR declined from 9.20 in 1999 to 3.55 in 2024 (AAPC, -3.66%; 95% CI, -4.34 to -2.97, p < 0.001). Mortality declined among men from 13.38 to 4.92 (AAPC, -3.85%) and women from 6.79 to 2.46 (AAPC, -3.92%; both p < 0.001). Mortality declined across all census regions, including Northeast (AAPC, -3.98%; p < 0.001), Midwest (AAPC, -3.76%; p < 0.001), South (AAPC, -3.93%; p < 0.001), and West (AAPC, -3.57%; p < 0.001), with the South having the higher AAMR (3.88) in 2024. Mortality remained higher in nonmetropolitan counties, with AAMR declining from 9.96 in 1999 to 4.42 in 2020 (AAPC, -4.05%; p < 0.001), compared with metropolitan counties, where the AAMR declined from 9.02 to 3.80 (AAPC, -4.31%; p < 0.001). Among non-Hispanic Black adults, the 2014-2024 trend was stable (APC, 1.13%; p = 0.12). Rates increased after 2010 among adults aged 35-44 years (APC, 6.65%; p < 0.001), 45-54 years (APC, 4.70%; p < 0.001), and 55-64 years (APC, 3.96%; p < 0.001).
CONCLUSION: Aspiration pneumonitis mortality with co-listed stroke declined nationally, but progress was uneven, with persistent demographic, regional, and rural disparities.