Parkinson’s disease is a common neurodegenerative disorder frequently complicated by aspiration pneumonia due to dysphagia and impaired cough reflex. Aspiration pneumonia markedly increases morbidity, mortality, and healthcare burden in Parkinson’s disease. However, comparative analyses of mortality and hospitalization trends in these patients remain unexplored.

A retrospective analysis of the CDC WONDER database (1999–2023) was conducted to assess mortality trends of Parkinson’s disease with and without aspiration pneumonia among U.S. adults aged ≥55 years. Age-adjusted mortality rates per 100,000 population were calculated and stratified by sex, race/ethnicity, urbanization, and census region. Joinpoint regression (JPR) analysis estimated annual percent changes (APCs) with 95% confidence intervals, using p < 0.05 for significance.

From 1999 to 2023, Parkinson’s disease caused 514,459 deaths, including 33,002 with multiple causes, showing three joinpoints: gradual rise from 1999–2014 (2.26%; p = 0.008), sharp increase from 2014–2017 (8.03%; p = 0.006), and plateau from 2017–2023 (1.79%; p = 0.066). Female mortality declined until 2019, then rose (10.71%; p = 0.004), while male mortality fell (–2.06%; p < 0.001). Hispanic and Black populations showed rising mortality, contrasting with stability in White and Asian groups. Mortality was highest in Washington (6.1) and lowest in Mississippi (1.4). Aspiration pneumonia deaths rose until 2021 (4.32%; p < 0.001) before stabilizing, with persistent rural excess.

Aspiration pneumonia remains the leading cause of death in Parkinson’s disease patients, with disparities across sex, race, and region. Early dysphagia screening and culturally tailored respiratory care can help reduce preventable deaths.