Lim, A

Abstract Purpose This study aimed to analyze mortality trends among patients with pneumonia and chronic kidney disease in the United States from 1999 to 2020. By examining patterns across urbanization levels, racial and ethnic groups, geographic regions, and sex, the study sought to identify significant changes over time and potential disparities in mortality outcomes. Methods Mortality data were extracted from the CDC WONDER database for patients diagnosed with pneumonia (ICD-10: J09-J18) and chronic kidney disease (ICD-10: N18). Trends were analyzed using Annual Percent Change (APC) with 95% confidence intervals (CI). Joinpoint regression was utilized to identify significant shifts in mortality trends over time. The analysis was stratified by urbanization level (Large Central Metro, Large Fringe Metro, Medium Metro, Small Metro, Micropolitan), ethnicity (American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, White), census region (Northeast, Midwest, South, West), Hispanic origin (Hispanic or Latino, Not Hispanic or Latino), and sex (Female, Male). Results From 2018 to 2020, significant increases in mortality were observed across all demographic and geographic categories. Urban areas, particularly Large Central Metro (APC = 39.4026%, p = 0.0008) and Small Metro (APC = 37.0284%, p = 0.0004), experienced the most pronounced rises. Ethnic disparities were evident, with Black or African American (APC = 49.9199%, p < 0.000001) and Hispanic or Latino (APC = 61.5742%, p < 0.000001) populations showing the highest mortality increases. By census region, the Midwest (APC = 35.7843%, p = 0.0004) and South (APC = 34.7972%, p = 0.0016) had the most significant spikes. Both females (APC = 36.0664%, p = 0.0004) and males (APC = 35.1504%, p < 0.000001) experienced substantial mortality increases, with females showing slightly higher rates. Conclusion The findings reveal significant increases in mortality from 2018 to 2020 across all analyzed categories, with notable disparities among racial, ethnic, and geographic groups. These trends highlight the need for further investigation into underlying causes and targeted interventions to address inequities. Clinical implications The results underscore the importance of addressing disparities in healthcare access and outcomes, particularly for Black or African American and Hispanic or Latino populations. Clinicians should focus on early diagnosis, effective management of comorbidities, and equitable resource distribution to mitigate mortality risks in high-risk groups. This abstract is funded by: None

Abstract Aim Acute respiratory distress syndrome (ARDS) is a life-threatening condition frequently managed in intensive care units, with high in-hospital mortality. Less is known about where mortality happens once care transitions beyond hospital. This study aimed to assess national trends in the location of ARDS-related deaths in the U.S. from 2003 to 2020 to evaluate racial and ethnic disparities in end-of-life settings. Methods A retrospective analysis was performed using Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) death certificate data from 2003 to 2020 for all decedents with ARDS (ICD-10 code J80) within the U.S. The proportion of deaths by location (medical facility, decedent’s home, hospice facility, nursing home/long-term care, and other/unknown) was calculated for each year. Linear regression was used to evaluate temporal trends in the proportion of deaths across the study period. Odds ratios (ORs) were calculated using 2 × 2 contingency tables to compare the likelihood of dying in a specific location (e.g., hospice facility, medical facility) between racial and ethnic groups. Results There were 29,028 ARDS deaths in the U.S. from 2003 to 2020. The majority (95.52%) of deaths occurred in medical facilities, with smaller proportions at nursing facilities (1.52%), home (1.50%), hospice (0.69%), other locations (0.33%), and unknown (0.43%). There were no significant changes in the proportions of deaths occurring in medical facilities, decedents’ homes, or nursing homes/long-term care facilities (P > .05 for all). However, the proportion of ARDS deaths occurring in hospitals increased significantly among Black (0.73% to 0.78% (P < .03)) and Asian/Pacific Islander patients (0.12% to 0.19% (P < .01)). Black patients had higher odds of dying in a medical facility compared to White patients (OR = 3.44). No ARDS decedents in the Asian or American Indian groups died outside a medical facility, yielding ORs that approached infinity for these groups. Conclusion The location of ARDS deaths in the U.S. remained largely constant from 2003 to 2020, with most patients dying in hospital settings. This highlights the severity of ARDS and its high in-hospital mortality, reflecting that intensive care is typically required for management. Despite advances in supportive therapies, the persistently high rate of in-hospital deaths suggests limited improvements in out-of-hospital transitions. This study also identified racial disparities. Black patients had higher odds of dying in medical facilities compared to White patients, suggesting inequities in access to home-based end-of-life care options. This abstract is funded by: None