A105-02 Divergent Racial Trends in COPD Mortality: A Population-Based Analysis of Emerging Disparities, 2018-2024

Abstract Rationale Despite overall decline in COPD mortality in recent decades, emerging evidence suggests persistent and widening racial disparities. Understanding contemporary trends is critical for targeted public health interventions and equitable respiratory care delivery. We hypothesized that racial and ethnic disparities in COPD mortality have widened from 2018-2024, with differential impacts from the COVID-19 pandemic on vulnerable populations. Methods We analyzed provisional mortality data from the CDC National Vital Statistics System (2018-2024) for adults aged 45+ years with COPD as underlying or contributing cause of death (ICD-10: J40-J47). Deaths were stratified by single/multiracial categories. We calculated absolute deaths, proportional burden shifts, and average annual percent change (AAPC) using linear regression for complete years 2018-2023. Pre-COVID (2018-2019), COVID-era (2020-2021), and post-COVID (2022-2024) periods were compared. Results Among 1,040,448 COPD deaths (2018-2024), overall mortality declined 8.8% (158,152→144,193). However, striking racial divergence emerged: White adults experienced 9.6% decline (143,408→129,689; AAPC: -1.93%/year, p = 0.031), while AIAN populations showed paradoxical 9.7% increase (785→861; AAPC: -0.46%/year, p = 0.946). Black adults demonstrated attenuated decline (2.6%; 11,308→11,019; AAPC: -1.33%/year, p = 0.148). Multiracial individuals increased 10.5% (601→664). Proportional burden shifted: White representation decreased from 90.7% to 89.9%, while Black and AIAN increased from 7.2% to 7.6% (+0.5pp) and 0.50% to 0.60% (+0.10pp). COVID-19 differentially impacted groups: 2019→2021, White deaths declined 10.2%, AIAN paradoxically increased 8.1%, Black showed minimal decline (1.9%). Post-2021 recovery varied: Asian populations recovered strongly (+6.1% by 2024) while AIAN showed minimal recovery (+0.3%), representing 19.3pp divergence between AIAN and White populations Conclusions This analysis reveals alarming divergent trends in COPD mortality with widening racial disparities (2018-2024). The paradoxical increase in AIAN deaths (+9.7%) and attenuated decline in Black mortality (-2.6%)—despite 9.6% national decline in White populations—represents a critical public health crisis. The 19.3pp divergence between AIAN and White populations, exacerbated during COVID-19 (18.3pp COVID-era disparity), reflects systemic inequities. COVID-19 worsened outcomes in vulnerable populations with minimal AIAN recovery post-2021 (+0.3% vs + 6.1% Asian recovery). Urgent actions required: (1) targeted screening/early intervention in AIAN and Black communities, (2) improved access to pulmonary rehabilitation via telehealth/mobile clinics, (3) culturally tailored smoking cessation programs, (4) investigation of social determinants (healthcare access, environmental exposures, structural racism), (5) increased Indian Health Service respiratory funding, and (6) mandatory race-stratified quality metrics. These findings demand immediate policy action to address this widening health equity gap. This abstract is funded by: None