This study examined trends and disparities related to Alzheimer’s Disease (AD) and Aspiration pneumonia (AP) among elderly patients in the U.S. by gender, race, urbanization, place of death, region, and state.

The CDC WONDER Multiple Cause of Death dataset (1999–2020) was used to analyze deaths in elderly U.S. patients (≥ 65 years) with ICD-10 codes J69 (AP) and G30 (AD). Age-adjusted mortality rates (AAMR) were calculated per 100,000 persons (95% CI) by standardizing crude mortality rates. Annual percent changes (APC) in AAMRs were analyzed using the Joinpoint regression model.

Between 1999 and 2020, 115,288 AP and AD-related deaths were reported, predominantly in nursing homes (49.3%), nearly double that in medical facilities. The overall AAMR remained stable initially, then declined from 2002 to 2020, with an average annual percentage change (AAPC) of -2.72 (95% CI: -3.24 to -2.08). Men had consistently higher AAMR than women from 1999 (AAMR men: 19.2 vs women: 13.4) to 2020 (AAMR men: 9.9 vs women: 7.7). The highest AAMR was observed in NH Whites (13), followed by Hispanic or Latinos (10.7). NH Whites and NH Blacks had significant declines (AAPC:  -2.95 vs AAPC: -2.07, respectively). Mortality declined similarly in urban and rural areas. Regionally, the highest AAMR was in the West (15.3), while Rhode Island showing the highest rate among all states (2.9). 

AP and AD-related mortality in elderly patients has significantly declined over the last two decades. However, significant disparities were noted among men, NH White patients, and nursing home residents. This data highlights the need to identify healthcare barriers for vulnerable populations.