Trends in Respiratory Failure–Associated Mortality Among Older Adults With Neurodegenerative Diseases in the United States (1999-2024)

Background Respiratory failure (RF) is a major contributor to morbidity and mortality among older adults, particularly in those with neurodegenerative diseases (NDDs). Despite the growing burden of NDDs, temporal trends in RF-associated mortality in this population remain insufficiently characterized. Methods A retrospective analysis was conducted using the CDC WONDER database (1999–2024). Mortality records for individuals aged ≥ 65 years with NDDs as the underlying cause of death and RF as a contributing cause were identified using ICD-10 codes. Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 100,000 population were calculated. Joinpoint regression was used to estimate annual percent change (APC) and average annual percent change (AAPC). Stratified analyses were performed by sex, age group, race/ethnicity, region, urbanization, and state. Results A total of 172,089 deaths were identified. Overall mortality increased significantly, with AAMR rising from 9.31 in 1999 to 22.04 in 2024 (AAPC = 3.69). Mortality was higher in males than in females and increased with advancing age, peaking in those aged ≥ 85 years. Hispanic individuals had the highest average AAMR, while consistent upward trends were observed across all racial groups. Regionally, the South reported the highest mortality burden. Non-metropolitan areas demonstrated a steeper increase compared to metropolitan regions. State-level analysis showed substantial geographic disparities, with consistently higher mortality in select states such as Arkansas and Mississippi. Conclusions RF-associated mortality among older adults with NDDs has increased significantly over the past two decades, with notable demographic and geographic disparities. These findings underscore the need for targeted interventions and improved multidisciplinary care strategies to mitigate mortality risk in this vulnerable population.