C55-32 Temporal Trends and Racial Disparities in ARDS Mortality Location in the United States (2003-2020)

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