Global patterns and cause composition of adolescent acute respiratory failure–related mortality, 1990–2023

BACKGROUND Acute respiratory failure (ARF) is a life-threatening clinical syndrome that often reflects limitations in timely access to emergency and critical respiratory care. Among adolescents, severe respiratory illness remains an important but poorly characterised contributor to preventable mortality. OBJECTIVE To describe long-term global trends and cause composition of adolescent ARF-related mortality, and assess changes associated with the coronavirus disease 2019 (COVID-19) pandemic. This was a descriptive analysis using a syndrome-based proxy derived from Global Burden of Disease 2023 cause-of-death estimates from 1990 to 2023. RESULTS Between 1990 and 2019, global adolescent ARF proxy deaths declined modestly, followed by a sharp increase during the COVID-19 pandemic, peaking in 2021. Before 2020, lower respiratory infections accounted for over 85% of ARF proxy mortality, with a stable cause composition. During 2020–2021, COVID-19 emerged as a major contributor, accounting for nearly half of ARF proxy deaths at its peak. By 2023, total ARF proxy mortality and cause structure returned toward pre-pandemic patterns. CONCLUSION Adolescent ARF-related mortality has declined modestly over three decades and shows a stable underlying structure re-emerging after the COVID-19 shock. These findings highlight persistent health-system vulnerabilities in delivering timely acute respiratory care for adolescents and support the need to strengthen emergency and critical care services alongside prevention.