Deaths involving both pneumonia and cerebrovascular disease among US adults aged 55 and older fell by about 80% between 1999 and 2019 and then rose sharply in 2020, coinciding with the COVID-19 pandemic, while disparities by sex, age, race and ethnicity, and urbanization persisted.
Age-adjusted mortality from pneumonia and cerebrovascular disease together fell about 80% from 1999 to 2019.
Mortality rose sharply in 2020, coinciding with the COVID-19 pandemic.
Mortality rates were consistently higher in men, adults aged 75 and older, and nonmetropolitan counties.
Non-Hispanic Black adults had the highest rates in every year except 2017.
The relative increase in 2020 was largest in several minority groups and in adults aged 55-74.
A sensitivity analysis with a broader pneumonia definition gave similar results.
The data are aggregate death certificate data and cannot identify causes of the trends or disparities.
This study looked at US death certificates from 1999 to 2020 for people aged 55 and older who had both pneumonia and cerebrovascular disease (such as stroke) listed among their causes of death. Over the 22 years, about 316,760 deaths involved both conditions. The age-adjusted death rate fell by about 80% between 1999 and 2019, from 45.4 to 9.1 per 100,000 people. In 2020, during the COVID-19 pandemic, the rate rose sharply to 15.8 per 100,000, about 74% higher than in 2019. The rise was seen in every group studied, but it was proportionally largest among American Indian or Alaska Native, Hispanic, and Black adults, and among adults aged 55-74. Throughout the period, rates were higher in men, in people aged 75 and older, and in nonmetropolitan areas. Black adults had the highest rates in nearly every year. The gaps between groups in absolute terms narrowed as overall rates fell. This research suggests that deaths from these combined conditions have declined substantially over time but remain unevenly distributed, and that the pandemic temporarily reversed some of the progress. The data come from death certificates, so they describe patterns but cannot show why they occurred. The authors say further studies with individual patient information are needed to test whether measures such as swallowing screening, vaccination, and infection prevention explain the decline and the disparities.
Abdullah M, Ali M, Mehmood T, Hassan M, Ali A, Jamil A, et al.. (2026). Trends and Disparities in Mortality From Pneumonia and Cerebrovascular Disease in the United States (1999-2020).. Brain and behavior. https://doi.org/10.1002/brb3.71849