MORTALITY TRENDS AND DEMOGRAPHIC DISPARITIES IN OPIOID-RELATED RESPIRATORY FAILURE IN THE US: A CDC WONDER ANALYSIS (1999-2020)

MIAN ZAHID JAN KAKAKHEL; HASAN Ilyas; MUHAMMAD USMAN Haider; SYEDA UMBREEN Munir; SAROSH Ali; FATIMA Naveed; ISHTIAQ Ahmad; ZARYAB Bacha; ABDULLAH Afridi; MUHAMMAD SIRTAJ Afridi; HAMNA Jawad; MADHO Mal

doi:10.1016/j.chest.2025.07.073

PURPOSE: Opioids are a class of drugs that primarily act in the brain to produce various effects, including pain relief. They also have multiple side effects, such as respiratory failure. Opioid-Induced Respiratory Depression (OIRD) is a major concern in the U.S. In 2022, nearly 108,000 people died from drug overdoses, with approximately 82,000 deaths linked to opioids.Among all side effects, OIRD is the most severe, leading to breathing failure and ultimately death if not treated promptly. This study analyzes trends and disparities in opioid-related respiratory failure deaths in the U.S. (1999–2020) to inform strategies for prevention, early intervention, and improved respiratory care in high-risk populations. METHODS: The study uses CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) to perform a retrospective analysis of deaths due to opioid-related respiratory failure in the United States from 1999 to 2020. The analysis uses ICD codes T40.0, T40.1, T40.2, T40.3, T40.4 and T40.6 for opioid- related mortality and J96.0, J96.9 and R09.2 for respiratory failure and related causes. Age-adjusted mortality rates (AAMRs) and annual percentage change (APC), along with 95% confidence intervals, were examined over time and across sex, racial/ethnic groups, and geographical regions using joinpoint analysis. RESULTS: From 1999 to 2020, there were 6955 total deaths due to opioid-related respiratory depression with an overall age-adjusted mortality rate (AAMR) of 1. The AAMR increased gradually from 0.4 in 1999 to 1.7 in 2020. Men consistently exhibited higher AAMR as compared to women, with rates increasing from 0.6 in men versus 0.2 in women in 1999 to 2.2 in men versus 1.2 in women by the year 2020. The NH White individuals recorded the highest AAMR in 2020 with (APC: 3.16; 95% Cl: 1.60 to 4.74), depicting a similar sex pattern showing highest AAMR i.e; 2.9 in White men as compared to 1.5 in White women by the year 2020. Significant geographical and regional differences were noted, with the highest AAMRs reported in the Midwest (1.4) and nonmetropolitan areas (1.8) compared to other census regions and metropolitan areas. Wyoming and Idaho had the highest AAMR trend at 4.8 from 1999 to 2020, whereas Virginia had the lowest at 0.1 during the same period. CONCLUSIONS: In our 22 years of analysis, we saw a slowly progressive rise in mortality due to opioid-related respiratory failure . Our analysis also showed higher death rates in males especially in NH White males. Geographically, the Midwest and Nonmetropolitan areas and Wyoming and Idaho had the highest mortality in 2020. CLINICAL IMPLICATIONS: This rising mortality rate due to opioid-related respiratory failure warrants wider availability of Naloxone, expanding supervised drug use programs, and improving emergency response. Increase access to addiction treatment, promote safer prescribing, and educate communities to prevent overdoses

MORTALITY TRENDS AND DEMOGRAPHIC DISPARITIES IN OPIOID-RELATED RESPIRATORY FAILURE IN THE US: A CDC WONDER ANALYSIS (1999-2020)

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