1999-2023年美国成人因OSA和呼吸衰竭导致的全国死亡率趋势：来自CDC-WONDER数据库的见解。

文献信息

中文摘要

背景： 阻塞性睡眠呼吸暂停（OSA）和呼吸衰竭（RF）在美国代表着日益增加的临床和公共卫生挑战，但全国死亡率趋势仍未被充分探索。本研究评估与OSA和RF相关的死亡率趋势，以突出针对不同人口学和地区的预防与管理。方法：使用CDC WONDER多死因（MCD）数据库，我们检索了1999年至2023年的死亡证明，以分析25岁及以上成人中与OSA和RF相关的死亡率。计算每10万人的年龄调整死亡率（AAMR），并按人口学和地区分类。使用Joinpoint回归估计年度百分比变化（APC）和平均APC。结果：共有71,202例死亡由OSA和RF导致。AAMR从1999年的0.25显著陡升至2023年的2.26（AAPC：9.3；95% CI：8.04至10.65，P < .01）。男性AAMR高于女性，1999年（男性：0.32；女性：0.21）至2023年（男性：2.79；女性：1.85）。在种族方面，非西班牙裔黑人AAMR增幅最高，从1999年的0.53升至2023年的2.16。非大都市地区的总体AAMR仍高于大都市地区（1.23 vs 1.01）。在地区方面，中西部负担最重，AAMR从1999年的0.21升至2023年的2.55。2020年州级AAMR范围为0.58（纽约州）至1.92（内布拉斯加州）。结论：利用1999年至2023年的全国回顾性数据，我们的研究显示，同时患有OSA和RF的成人面临稳步上升的死亡率，在美国不同人口学群体和地理区域之间观察到显著差异，强调采取量身定制策略的重要性，例如扩大早期检测的可及性，并确保公平的医疗服务提供，以降低此类患者的死亡率并改善结局，尤其是在受影响不成比例的群体和地区。

英文摘要

Obstructive sleep apnea (OSA) and respiratory failure (RF) represent increasing clinical and public health challenges in the United States, yet national trends in mortality remain underexplored. This study evaluates trends in mortality associated with OSA and RF to highlight targeted prevention and management across demographics and regions. Using the CDC WONDER multiple cause of death (MCD) database, we retrieved death certificates from 1999 to 2023 to analyze mortality related to OSA and RF among adults aged ≥ 25 years. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated and categorized by demographics and region. Joinpoint regression was used to estimate annual percent change (APC) and average APC. A total of 71,202 deaths occurred due to OSA and RF. The AAMR observed a significant and steep incline from 0.25 in 1999 to 2.26 in 2023 (AAPC: 9.3; 95% CI: 8.04 to 10.65, P < .01). Men had higher AAMRs than women (men: 0.32; women: 0.21) in 1999 to (men: 2.79; women: 1.85) in 2023. Racially, NH Blacks demonstrated the highest increase in AAMR from 0.53 in 1999 to 2.16 in 2023.The overall AAMR remained higher in nonmetropolitan areas compared to metropolitan areas (1.23 vs 1.01). Regionally, the Midwest recorded the greatest burden with AAMR increasing from 0.21 in 1999 to 2.55 in 2023. State-level AAMRs ranged from 0.58 (New York) to 1.92 (Nebraska) in 2020. Using nationwide retrospective data from 1999 to 2023, our study revealed that adults with concomitant OSA and RF face steadily rising mortality rates, with marked differences observed across demographic groups and geographic regions in the U.S., underscoring the importance of tailored strategies such as expanding access to early detection, and ensuring equitable healthcare delivery to reduce mortality and improve outcomes among such patients, particularly in disproportionately affected populations and regions.