What is the clinical evidence from this study?

Study design: Observational. Population: Acute respiratory distress syndrome (ARDS) (n=144180). Intervention: COVID-19 pandemic vs. Pre-pandemic period (2018-2019). Primary outcome: Age-adjusted mortality rates (AAMRs) per 100,000 population for ARDS.

What does this research mean for the field?

The COVID-19 pandemic increased the overall age-adjusted mortality rate for ARDS from 2.8 per 100,000 in 2018-2019 to 13.4 in 2020-2021, with significant racial and ethnic disparities disproportionately affecting Native Hawaiian/Other Pacific Islander, American Indian/Alaska Native, Black, and Hispanic populations. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to investigate the racial and ethnic disparities in mortality due to acute respiratory distress syndrome (ARDS) during the COVID-19 pandemic in the US.

May 20, 2026

A37-21 Racial and Ethnic Disparities in Acute Respiratory Distress Syndrome Related Mortality During the COVID-19 Pandemic: A U.S. Population-based Study From 2018 to 2023

Key Result

The COVID-19 pandemic increased the overall age-adjusted mortality rate for ARDS from 2.8 per 100,000 in 2018-2019 to 13.4 in 2020-2021, with significant racial and ethnic disparities.

Key Points

This study aims to investigate the racial and ethnic disparities in mortality due to acute respiratory distress syndrome (ARDS) during the COVID-19 pandemic in the US.
Utilized the CDC WONDER database from 2018-2023 to extract age-adjusted mortality rates for ARDS.
Stratified mortality rates by demographic factors including age, sex, race, and Hispanic origin.
Analyzed ARDS mortality data attributed to COVID-19 during and after the pandemic.
Overall ARDS mortality rate increased nearly fivefold during the early pandemic, with 82.8% linked to COVID-19.
Highest mortality observed in Native Hawaiian/Other Pacific Islanders, followed by American Indian/Alaska Native and African American populations.
Mortality disparities persisted post-peak, highlighting the need for focused interventions to address these inequalities.

Study Design

Type

Observational (n=144,180)

Multicenter

Yes

Structured PICO

Population

U.S. population from 2018 to 2023, analyzing 144,180 deaths attributed to ARDS from 2020-2023.

Outcome

Age-adjusted mortality rates (AAMRs) per 100,000 population for ARDS as Multiple cause of deathhard clinical

The COVID-19 pandemic caused a nearly fivefold increase in ARDS mortality in the US, exposing severe racial and ethnic disparities that require targeted interventions.

Main Result

Absolute Event Rate: 13.4% vs 2.8%

Abstract

Abstract Rationale Acute respiratory distress syndrome (ARDS) is a major contributor to critical illness mortality. COVID-19 reshaped ARDS epidemiology in the US, but demographic patterns remain unexplored. Methods We used the CDC WONDER database from 2018-2023 to extract age-adjusted mortality rates (AAMRs) per 100,000 population for ARDS as Multiple cause of death. AAMR were stratified by age, sex, race, Hispanic origin, and census region. ARDS mortality with COVID-19 as underlying cause of death was extracted to study attribution to total ARDS mortality during and after the pandemic. Results There were total of 144,180 deaths attributed to ARDS from 2020-2023, out of which 105,454 were due to COVID19. The overall AAMR for ARDS was 2.8/100,000 in 2018-2019, rising sharply to 13.4 in 2020-2021 before declining to 4.4 in 2022-2023. COVID-19 accounted for 82.8% of ARDS deaths in 2020-2021 and 43.2% in 2022-2023 and the AAMR for ARDS due to COVID was 11.1 during the peak, which dropped to 1.9 after the peak. Racial disparities were prominent as Native Hawaiian/Other Pacific Islanders (NH/OPI) experienced highest increase in AAMR during the pandemic (29.2, baseline before COVID-19 was 3.4), followed by American Indian/Alaska Native (AI/AN) (24.8 vs 3.8) and African Americans (20.0 vs 3.1), while White and Asian populations peaked lower (12.6 vs 2.7 and 10.6 vs 2.1, respectively). Hispanics showed the most dramatic trajectory, increasing from 2.7 to 24.6 (+811%) before falling to 5.4 after pandemic, whereas non-Hispanics increased from 2.8 to 11.9. AAMR for men increased from 3.1 at baseline to 17.3, compared with 2.5 to 10.1 in females, and remained higher in 2022-2023 (5.2 males vs 3.7 females). By age, ARDS mortality was highest among adults ≥65 years, rising from 10.7 to 59.9 in 2020-2021 before declining to 18.8 in 2022-2023, with COVID-19 accounting for nearly 85% of peak deaths vs 47% after peak. AAMR for adults aged 45-64 years increased from 4.1 to 19.6 before declining to 6.2, with 83% attributable to COVID-19 at the peak. Regionally, 2020-2021 AAMR was highest in the West (14.9) and Northeast (14.3) compared with the South (13.7) and Midwest (10.3). Conclusion ARDS mortality in the US increased nearly fivefold in early COVID-19, with 82.8% of AAMR linked to COVID-19. By 2022-2023, mortality declined markedly yet remained above pre-pandemic levels. The most burden was borne by NH/OPI, AI/AN, Black, and Hispanic populations, showing significant racial disparities in ARDS outcomes and the need for targeted interventions. This abstract is funded by: None

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Cite This Study

Ahmad et al. (Fri,) conducted a observational in Acute respiratory distress syndrome (ARDS) (n=144,180). COVID-19 pandemic vs. Pre-pandemic period (2018-2019) was evaluated on Age-adjusted mortality rates (AAMRs) per 100,000 population for ARDS. The COVID-19 pandemic increased the overall age-adjusted mortality rate for ARDS from 2.8 per 100,000 in 2018-2019 to 13.4 in 2020-2021, with significant racial and ethnic disparities.

synapsesocial.com/papers/6a0d50aef03e14405aa9c993 https://doi.org/https://doi.org/10.1093/ajrccm/aamag162.043

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