Abstract Background Mechanical ventilation is a cornerstone of intensive care for patients with respiratory failure, yet mortality outcomes remain highly variable across geographic regions, racial groups, and genders. These disparities reflect the interaction of biological, socioeconomic, and structural factors that influence access to critical care. Understanding long-term national wide trends is essential to promoting healthcare equity in intensive care delivery, particularly in the aftermath of the COVID-19 pandemic. Methods A retrospective analysis was conducted using CDC WONDER Multiple Cause of Death data from 1999 to 2020. Deaths associated with ventilation-related conditions, including acute respiratory distress syndrome (J80) and respiratory failure (J96.x), were identified. Age-adjusted mortality rates per 100,000 population were calculated and stratified by race, gender, and state. Temporal patterns were evaluated to identify disparities across a 21-year period, comparing pre-pandemic (1999-2019) and pandemic (2020) years. Results From 1999 to 2019, national mortality rates for ventilation-related causes declined by 21.4% (from 41.2 to 32.4 deaths per 100,000). In 2020, mortality increased by 53.2%, reaching 49.6 deaths per 100,000, equating to approximately 540,000 deaths nationally.•Racial disparities: Black or African American individuals had the highest average mortality (41.8/100,000) compared with White (36.7/100,000) and Asian/Pacific Islander populations (24.2/100,000). The Black-White mortality gap widened by 12% during the pandemic year.•Geographic variation: The states with the highest average mortality were Mississippi (42.3), District of Columbia (38.8), Arkansas (38.8), Connecticut (38.6), and West Virginia (38.3) per 100,000, showing 25-35% increases in 2020 mortality.•Gender disparities: Men consistently had higher mortality than women (average 34.9 vs. 32.1 deaths per 100,000), with the gap widening by 8.1 deaths per 100,000 in 2020 (men: 55.9, women: 47.8) Discussion The above data demonstrated that racial, geographical, structural inequities and healthcare system limitations have shaped ventilation-related mortality for decades. Persistent racial and regional differences likely arise from unequal ICU access, comorbidity burdens, and broader social determinants of health such as poverty, education, and environmental exposure. The sharp rise in 2020 underscores how COVID-19 pandemic exacerbated preexisting disparities.Conclusions and Impact:Mortality associated with mechanical ventilation exhibits persistent, multifactorial disparities across race, geography, and gender. Addressing these inequities requires equitable ICU resource allocation, investment in public health infrastructure, and culturally informed policies to reduce preventable deaths and strengthen resilience within the U.S. critical care system This abstract is funded by: None
Mbome et al. (Fri,) studied this question.