{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:57:01Z","timestamp":1790607421990,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Public Health Challenges"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>There was an increase in pneumothorax\u2010related deaths in the United States during the COVID\u201019 pandemic era, likely due to the load on the healthcare system and as a complication following the viral infection itself.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To analyze the mortality trends, variations, and most affected demographic subgroups in pneumothorax\u2010related deaths before and during the COVID\u201019 pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective\u2010cohort\u2010study was conducted using patient data, which was collected using the Centers for Disease Control and Prevention Wide\u2010Ranging Online Data for Epidemiological Research (CDC WONDER) database for deaths from pneumothorax before (1999\u20132019) and during the COVID\u201019 pandemic (2020\u20132021). Age\u2010adjusted mortality rates (AAMRs) were calculated per 100,000, and analysis was performed by Joinpoint, which estimated average annual\u2010percentage\u2010change (AAPC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 74,799 deaths occurred from pneumothorax from 1999 to 2021. Pneumothorax mortality rates were low before the pandemic (AAPC, \u22120.306 and AAMR, 0.8) but reversed during the pandemic (AAMR, 2.15; AAPC, 79.94). Overall, during the pandemic, the AAMRs were greater for men, NH\u2010American Indians\/Alaska Natives, the Southern region, and adults aged \u226565 years. Mortality rates varied regionally, with the highest in Kentucky (4.1) and the lowest in Maine (0.5). States like South Carolina, Tennessee, Wyoming, Texas, Kentucky, and West Virginia fell into the 90th percentile. The sharpest increase was observed among American Indian people (AAPC, 169.74), non\u2010Hispanic Black people (AAPC, 64.82), Hispanic people (AAPC, 151.67), younger adults (AAPC, 156.19), the Southern region (AAPC, 70), females (AAPC, 78.78), and older adults (AAPC, 56.414) for pneumothorax\u2010related mortality during the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>As pneumothorax was identified using multiple cause\u2010of\u2010death records, these findings should be interpreted as describing mortality patterns in which pneumothorax contributed to death rather than establishing pneumothorax as the primary cause. Continued surveillance and further studies incorporating clinical\u2010level data are warranted to better understand the drivers of these observed trends.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/puh2.70322","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T14:42:33Z","timestamp":1785508953000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends and Disparities in Pneumothorax\u2010Related Deaths in the United States Before and During the COVID\u201019 Pandemic: A CDC WONDER Database Analysis"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9750-8472","authenticated-orcid":false,"given":"Mariam","family":"Idrees","sequence":"first","affiliation":[{"name":"Foundation University Medical College  Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2755-2493","authenticated-orcid":false,"given":"Eman","family":"Imtisal","sequence":"additional","affiliation":[{"name":"Foundation University Medical College  Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warda Fatima","family":"Shafee","sequence":"additional","affiliation":[{"name":"Nishtar Medical University  Multan Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0717-2777","authenticated-orcid":false,"given":"Muddassir","family":"Khalid","sequence":"additional","affiliation":[{"name":"Nishtar Medical University  Multan Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7549-071X","authenticated-orcid":false,"given":"Taha Mazhar","family":"Awan","sequence":"additional","affiliation":[{"name":"Foundation University Medical College  Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3639-7755","authenticated-orcid":false,"given":"Syeda Fatima Harrum","family":"Bukhari","sequence":"additional","affiliation":[{"name":"Foundation University Medical College  Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8057-6500","authenticated-orcid":false,"given":"Fatima Yasmeen","family":"Awan","sequence":"additional","affiliation":[{"name":"Islamic International Medical College Riphah International University  Rawalpindi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4301-0646","authenticated-orcid":false,"given":"Fatima","family":"Idrees","sequence":"additional","affiliation":[{"name":"Rawalpindi Medical University  Rawalpindi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5450-4787","authenticated-orcid":false,"given":"Sumia","family":"Fatima","sequence":"additional","affiliation":[{"name":"Rawalpindi Medical University  Rawalpindi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7539-1052","authenticated-orcid":false,"given":"Rida","family":"Noor","sequence":"additional","affiliation":[{"name":"Bolan Medical College  Quetta Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5613-9650","authenticated-orcid":false,"given":"Asad","family":"Khan","sequence":"additional","affiliation":[{"name":"Bacha Khan Medical College  Mardan Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7441-9135","authenticated-orcid":false,"given":"Fred","family":"Segawa","sequence":"additional","affiliation":[{"name":"Makerere University College of Health Sciences, Central Region  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.125.6.2345"},{"issue":"6","key":"e_1_2_13_3_1","first-page":"1379","article-title":"Incidence of Spontaneous Pneumothorax in Olmsted County, Minnesota: 1950 to 1974","volume":"120","author":"Melton L. 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