Shifting patterns of acute respiratory infection mortality in Australia: Changing contributions of COVID-19, influenza and respiratory syncytial virus and persistent Indigenous inequalities

Objectives Acute respiratory infections (ARI) remain a major cause of mortality, particularly among older adults. In the post-pandemic period, patterns of respiratory mortality have shifted, with changing contributions from COVID-19, influenza and respiratory syncytial virus (RSV), creating important implications for prevention and health equity in Australia. Methods Provisional national mortality statistics from the Australian Bureau of Statistics (ABS), based on ICD-10 coded cause of death registrations, were analysed for deaths involving COVID-19, influenza and RSV. Temporal patterns were examined for 2023–2025, while age and sex-specific analyses were pooled across years. Inequalities in COVID-19 mortality between Aboriginal and Torres Strait Islander and non-Indigenous Australians were assessed using age-standardised death rates (ASDRs) for 2022–2025. Results COVID-19 remained the leading cause of ARI mortality but declined substantially over the study period, while influenza-associated deaths increased and RSV mortality rose modestly. Mortality was concentrated among older adults, with 70.8% of deaths occurring among people aged ≥80 years, and mortality was slightly higher among males. Marked inequalities in COVID-19 mortality were observed, with ASDRs substantially higher among Aboriginal and Torres Strait Islander people than non-Indigenous Australians. Conclusions ARI mortality in Australia during the post-pandemic period was characterised by declining COVID-19 mortality, increasing influenza mortality, continued RSV burden, strong age concentration and persistent Indigenous inequalities. These findings support continued respiratory surveillance and targeted prevention strategies for older adults and Aboriginal and Torres Strait Islander populations.