The US death rate from flu and pneumonia fell 29.2 percent among adults between 1999 and 2023 — a quarter-century decline researchers say tracks with sustained investment in prevention, with one statistically significant exception. [1]
The analysis, published in the journal Medicine, drew on the Centers for Disease Control and Prevention's WONDER mortality database. Researchers found the age-adjusted death rate for the two paired respiratory illnesses dropped from 35.9 to 16.5 per 100,000 residents, a 3.2 percent average annual decline. [1] Total deaths fell from 63,006 in 1999 to 44,625 in 2023, even as the US population grew.
The gains were not evenly distributed. Men died at consistently higher rates than women throughout the period — 43.7 versus 31.4 per 100,000 in 1999, narrowing to 19.5 versus 14.2 by 2023 — though both sexes saw the burden roughly halve. Black adults carried the highest death rate of any racial group in 1999, at 38.7 per 100,000, and posted the sharpest relative improvement of any group by 2023, falling to 19.0. Rural counties out-died metropolitan ones at both ends of the study window, 40.0 versus 35.1 per 100,000 in 1999 and 23.5 versus 19.3 by 2020. Adults 85 and older had by far the highest crude death rate of any age group, peaking near 752 per 100,000 in 1999 — and then falling substantially as the oldest Americans benefited disproportionately from vaccination campaigns, antiviral treatments and pneumococcal conjugate vaccines introduced over the study period. [1]
One group moved the wrong direction. Adults aged 55 to 64 were the only age band with a statistically significant rise in crude death rate over the 25 years, climbing at an average of 0.8 percent a year. [1] The study's authors, a team based in China, did not identify a cause, writing only that "further research incorporating individual-level risk factors, vaccination data, and pathogen-specific coding is needed to clarify the drivers of these trends and disparities." [1]
That gap is enough to complicate a clean read in either direction. A pure success story ignores the one cohort where the numbers got worse for a quarter century running. A pure alarm ignores that every other age group, including the oldest and most vulnerable, improved substantially over the same period. The researchers frame the overall decline as consistent with "nationwide advances in respiratory disease prevention and sustained investment in public health infrastructure" — a case for continuity at a moment when that infrastructure's funding is contested. [1]
The study's authors, writing in the journal Medicine, did not have access to individual-level data on vaccination status, smoking, obesity or other chronic conditions that might explain why people in their late 50s and early 60s bucked a 25-year national trend everyone around them followed. That gap in the data is itself part of the finding: a national mortality database built from death certificates can show researchers exactly which group is moving the wrong way without telling them why.
The mid-life exception is the harder story to tell, because the data offers no answer yet for why one generation's flu-and-pneumonia risk moved opposite everyone else's — and because the researchers who found it were careful enough to say so rather than guess.
-- NORA WHITFIELD, Chicago