Chest
Volume 119, Issue 4, April 2001, Pages 1179-1184
Journal home page for Chest

Clinical Investigations in Critical Care
Risk Factors for ARDS in the United States: Analysis of the 1993 National Mortality Followback Study

https://doi.org/10.1378/chest.119.4.1179Get rights and content

Objective

To identify specific comorbid factors that are present in US decedents with ARDS.

Design

We searched the 1993 National Mortality Followback Study for all decedents who had a code for ARDS mentioned on their death certificate. We also searched for comorbid conditions both on the death certificates (sepsis, medical or surgical misadventures, cirrhosis) and in the study database (current or former smoking, use of alcohol at least 3 d/wk, race, gender, and age). We calculated proportional mortality ratios (PMRs) for these risk factors.

Results

Of the 19,003 decedents for whom data were available, 252 decedents, representing an estimated 19,460 US decedents, had ARDS listed on their death certificate. PMRs among decedents with ARDS were significantly increased for medical or surgical misadventures (PMR, 11.8; 95% confidence interval [CI], 3.8 to 36.7), sepsis (PMR, 5.6; 95% CI, 2.0 to 16.0), nonwhite race (PMR, 2.6; 95% CI, 1.4 to 5.0), and cirrhosis (PMR, 2.2; 95% CI, 1.1 to 4.6). PMRs were increased but not statistically significant for current smokers (PMR, 1.2; 95% CI, 0.5 to 3.0) or former smokers (PMR, 1.8; 95% CI, 0.7 to 4.3) compared to never smokers, and drinking alcohol on ≥≥ 3 d/wk in the year prior to death, when compared to drinking alcohol less than < 3 d/wk (PMR, 1.8; 95% CI, 0.6 to 4.9).

Conclusions

The results of this study confirm the positive associations between ARDS mortality and the presence of sepsis and cirrhosis, and suggest possible new relationships between ARDS mortality and nonwhite individuals and patients with medical or surgical misadventures.

Section snippets

Materials and Methods

The 1993 National Mortality Followback Study (NMFS) is a multicomponent survey conducted by the National Center for Health Statistics designed to supplement information from death certificates in the vital statistics file with information on important characteristics of the decedent. The survey included individuals aged≥≥ 15 years who died in 1993 in the United States. A total of 22,957 death certificates or approximately 1% of the total cohort was sampled. In order to produce more robust

Results

Data were available for 19,003 decedents in the 1993 NMFS, which was weighted to reflect the 2.2 million annual deaths. The overall weighted study population included 49% female and 51% male decedents. Nearly 86% of the decedents were white, and 14.1% were nonwhite. Over 1.6 million (74.4%) of the decedents were > 64 years old at the time of their death. In the entire study cohort, 4.1% (n = 91,370) had a diagnosis of sepsis, 1.2% (n = 26,470) had a diagnoses of a surgical or medical

Discussion

In this study, we examined the impact of several comorbid conditions and demographic variables on ARDS mortality using a large national database. The 1993 NMFS is unique in that information is obtained from both death certificate records as well as from extensive survivor interviews. Our results indicate that individuals who died with ARDS were more likely to have a diagnosis of sepsis, medical or surgical misadventure, or cirrhosis. In addition, the adjusted PMR was significantly higher for

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    Funding was provided by grant R01-AA11660––01A2 from the National Institutes of Health.

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