Trends and Disparities in Pneumothorax‐Related Deaths in the United States Before and During the COVID‐19 Pandemic: A CDC WONDER Database Analysis

Background: There was an increase in pneumothorax-related deaths in the United States during the COVID-19 pandemic era, likely due to the load on the healthcare system and as a complication following the viral infection itself. Aims: To analyze the mortality trends, variations, and most affected demographic subgroups in pneumothorax-related deaths before and during the COVID-19 pandemic. Methods: A retrospective-cohort-study was conducted using patient data, which was collected using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database for deaths from pneumothorax before (1999-2019) and during the COVID-19 pandemic (2020-2021). Age-adjusted mortality rates (AAMRs) were calculated per 100,000, and analysis was performed by Joinpoint, which estimated average annual-percentage-change (AAPC). Results: A total of 74,799 deaths occurred from pneumothorax from 1999 to 2021. Pneumothorax mortality rates were low before the pandemic (AAPC, -0.306 and AAMR, 0.8) but reversed during the pandemic (AAMR, 2.15; AAPC, 79.94). Overall, during the pandemic, the AAMRs were greater for men, NH-American Indians/Alaska Natives, the Southern region, and adults aged ≥65 years. Mortality rates varied regionally, with the highest in Kentucky (4.1) and the lowest in Maine (0.5). States like South Carolina, Tennessee, Wyoming, Texas, Kentucky, and West Virginia fell into the 90th percentile. The sharpest increase was observed among American Indian people (AAPC, 169.74), non-Hispanic Black people (AAPC, 64.82), Hispanic people (AAPC, 151.67), younger adults (AAPC, 156.19), the Southern region (AAPC, 70), females (AAPC, 78.78), and older adults (AAPC, 56.414) for pneumothorax-related mortality during the pandemic. Conclusions: As pneumothorax was identified using multiple cause-of-death records, these findings should be interpreted as describing mortality patterns in which pneumothorax contributed to death rather than establishing pneumothorax as the primary cause. Continued surveillance and further studies incorporating clinical-level data are warranted to better understand the drivers of these observed trends.