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From 1999 to 2023, the US age-adjusted adult death rate from influenza and pneumonia plummeted 29.2%, with the only statistically significant rise in crude death rates in adults aged 55 to 64, per a study published in Medicine.

Researchers in China examined the Centers for Disease Control and Prevention’s WONDER public death repository to identify those caused primarily by flu or pneumonia. 

“Influenza and pneumonia form a paired respiratory hazard that imposes enduring public health pressure within the United States, generating extensive annual cases, premature deaths, and overloading local medical service systems year after year,” the authors wrote. 

“Influenza viral infection often weakens lower respiratory tract defenses, raising the risk of secondary pneumonia development,” they added.

Declines align with investment, advances in prevention

The total number of influenza and pneumonia-related deaths fell from 63,006 in 1999 to 44,625 in 2023, a 29.2% reduction. The national age-adjusted death rate for flu and pneumonia declined from 35.9 to 16.5 per 100,000 residents (average yearly decline, 3.2%). 

Further research incorporating individual-level risk factors, vaccination data, and pathogen-specific coding is needed to clarify the drivers of these trends and disparities.

Death rates were consistently higher for men than for women (43.7 vs 31.4/100,000 in 1999 and 19.5 vs 14.2/100,000 in 2023). Black adults had the highest death burden in 1999 (38.7/100,000) but saw the most marked relative reduction by 2023 (19.0/100,000). 

Rural counties had higher age-adjusted death rates than metropolitan areas (40.0 vs 35.1/100,000 in 1999 and 23.5 vs 19.3/100,000 in 2020). Adults 85 and older had the highest crude death rate, which peaked at 751.8/100,000 people in 1999. Of note, people aged 55 to 64 made up the only group with a statistically significant rise in crude death rate (average annual change, 0.8%). 

The declines align with nationwide advances in respiratory disease prevention and sustained investment in public health infrastructure, the researchers said.

“These findings highlight key population-level patterns and inequalities,” they concluded. “Further research incorporating individual-level risk factors, vaccination data, and pathogen-specific coding is needed to clarify the drivers of these trends and disparities.”