Trends and Disparities in Aspiration Pneumonitis Mortality With Co-Listed Stroke Among US Adults, 1999-2024: A CDC WONDER Analysis.

BACKGROUND: Aspiration pneumonitis is a serious poststroke respiratory complication, yet contemporary US mortality trends involving aspiration pneumonitis as the underlying cause of death with co-listed stroke remain unclear. We evaluated national trends and disparities in aspiration pneumonitis mortality with co-listed stroke among US adults aged ≥ 25 years from 1999 to 2024. METHODS: We conducted a retrospective, population-based serial cross-sectional analysis of CDC WONDER multiple cause of death data from 1999 through 2024. Deaths were included when aspiration pneumonitis (ICD-10 J69.0) was the underlying cause and stroke (I60-I69) was a contributing cause among adults aged ≥ 25 years. Age-adjusted mortality rates (AAMRs) per 100,000 population were standardized to the 2000 US population; age-specific rates were crude. Joinpoint regression estimated annual percent changes (APCs) and average annual percent changes (AAPCs). RESULTS: A total of 296,691 deaths were identified. The overall AAMR declined from 9.20 in 1999 to 3.55 in 2024 (AAPC, -3.66%; 95% CI, -4.34 to -2.97, p < 0.001). Mortality declined among men from 13.38 to 4.92 (AAPC, -3.85%) and women from 6.79 to 2.46 (AAPC, -3.92%; both p < 0.001). Mortality declined across all census regions, including Northeast (AAPC, -3.98%; p < 0.001), Midwest (AAPC, -3.76%; p < 0.001), South (AAPC, -3.93%; p < 0.001), and West (AAPC, -3.57%; p < 0.001), with the South having the higher AAMR (3.88) in 2024. Mortality remained higher in nonmetropolitan counties, with AAMR declining from 9.96 in 1999 to 4.42 in 2020 (AAPC, -4.05%; p < 0.001), compared with metropolitan counties, where the AAMR declined from 9.02 to 3.80 (AAPC, -4.31%; p < 0.001). Among non-Hispanic Black adults, the 2014-2024 trend was stable (APC, 1.13%; p = 0.12). Rates increased after 2010 among adults aged 35-44 years (APC, 6.65%; p < 0.001), 45-54 years (APC, 4.70%; p < 0.001), and 55-64 years (APC, 3.96%; p < 0.001). CONCLUSION: Aspiration pneumonitis mortality with co-listed stroke declined nationally, but progress was uneven, with persistent demographic, regional, and rural disparities.