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.
Observational (n=144,180)
Yes
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.
Absolute Event Rate: 13.4% vs 2.8%
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
Ahmad et al. (2026) conducted an 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.