Deaths Involving Head and Neck Injuries and Respiratory Failure, 1999–2025: A Population-Based CDC WONDER Mortality Analysis

Background: Respiratory failure is a major complication of neurotrauma, including traumatic brain injury and cervical spinal cord injury, but national mortality patterns involving co-reported head or neck injury and acute respiratory failure remain insufficiently described. This study evaluated temporal trends and demographic, geographic, and place-of-death disparities in U.S. mortality involving head or neck injuries with acute respiratory failure from 1999 to 2025. Methods: We conducted a population-based descriptive analysis using the CDC WONDER Multiple Cause-of-Death database. Deaths were included when ICD-10 codes for head injury or neck injury (S00–S09 or S10–S19) and acute respiratory failure (J96.0) were reported anywhere on the death certificate. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and stratified by sex, age group, race/ethnicity, census region, state, metropolitan status, and place of death. Temporal trends were assessed using Joinpoint regression and reported as annual percent changes (APCs) with 95% confidence intervals (CIs). Results: From 1999 to 2025, 29,574 deaths involved head or neck injuries with acute respiratory failure. The overall AAMR increased from 0.2 in 1999 to 0.5 in 2025, representing a significant upward trend (APC, 4.2%; 95% CI, 3.6–5.2). Men consistently had higher mortality rates than women, and adults aged 65 years or older had the greatest mortality burden. Rates were generally highest among non-Hispanic White individuals and lowest among Hispanic or Latino individuals. Nonmetropolitan areas had persistently higher mortality rates than metropolitan areas, and most deaths occurred in medical facilities. Conclusions: Mortality involving head or neck injuries with acute respiratory failure increased substantially in the United States between 1999 and 2025, with pronounced disparities by sex, age, race/ethnicity, geography, and metropolitan status. These findings suggest that acute respiratory failure is an important terminal pathway after neurotrauma and highlight the need for improved respiratory surveillance, timely critical care access, and targeted neurocritical care strategies for high-risk populations.