{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T05:13:01Z","timestamp":1783746781325,"version":"3.55.0"},"reference-count":51,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Respiratory failure (RF) is a frequently fatal complication of chronic liver disease (CLD), yet population-level data on RF-related mortality trends among adults with CLD are lacking. This study characterized temporal trends and demographic disparities in RF-related mortality among U.S. adults with CLD from 1999 to 2024. Methods: Death certificate data were obtained from the CDC WONDER database for adults aged \u226525 years with both RF (ICD-10: J96) and CLD (ICD-10: K70\u2013K76) listed as an underlying or contributing cause of death. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Joinpoint regression identified temporal inflection points and annual percentage change (APC). Results: Among 241,075 deaths, the overall AAMR increased 3.2-fold from 2.237 (1999) to 7.162 (2021) per 100,000, then declined to 6.132 by 2024. Joinpoint analysis identified four segments: moderate increase (1999\u20132006; APC +2.40%), accelerated increase (2006\u20132018; APC +5.37%), late acceleration period (2018\u20132021; APC +13.10%), and post-pandemic decline (2021\u20132024; APC \u22124.32%; all p &lt; 0.001). The 2024 AAMR remained 174.2% above baseline. The male-to-female rate ratio narrowed from 2.02 to 1.50, with females showing steeper acceleration (+14.38% vs. +12.36%). American Indian or Alaska Native individuals had the highest AAMRs and the most dramatic surge (APC +26.90%). Rural areas surpassed urban AAMRs by 2020, with steeper post-2007 acceleration (+8.74% vs. +5.51%). The Western U.S. consistently had the highest regional rates. Younger adults aged 25\u201334 and 35\u201344 showed 2.96-fold and 2.37-fold increases in crude mortality rates, respectively. Approximately 80% of deaths occurred in inpatient settings. Conclusions: RF-related mortality among U.S. adults with CLD increased more than threefold from 1999 to 2021, with a dramatic surge followed by incomplete decline. Persistent disparities by sex, race\/ethnicity, urbanization, and region highlight the need for targeted interventions, including expanded screening for alcohol-associated and metabolic liver disease and improved access to hepatology services in underserved communities.<\/jats:p>","DOI":"10.3390\/diseases14070241","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T14:33:06Z","timestamp":1783089186000},"page":"241","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Temporal Trends and Demographic Disparities in Respiratory Failure Mortality Among Adults with Chronic Liver Disease: A National Mortality Database Analysis, 1999 to 2024"],"prefix":"10.3390","volume":"14","author":[{"given":"Shubhendu","family":"Bajpai","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4146-7787","authenticated-orcid":false,"given":"Abdullah","family":"Sultany","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Sarmad","family":"Aleem","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahil","family":"Grover","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf","family":"Ullah","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4611-956X","authenticated-orcid":false,"given":"Eshal","family":"Amir","sequence":"additional","affiliation":[{"name":"MBBS Program, Shadman Campus, College of Medicine, FMH, Lahore 54000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Carroll","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Zain","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6100-7626","authenticated-orcid":false,"given":"Rewanth","family":"Katamreddy","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Guthrie Robert Packer Hospital, Sayre, PA 18840, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8544-9039","authenticated-orcid":false,"given":"Dushyant Singh","family":"Dahiya","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Motility, School of Medicine, University of Kansas, Kansas City, KS 66160, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Bernshteyn","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Guthrie Robert Packer Hospital, Sayre, PA 18840, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Breslin","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Guthrie Robert Packer Hospital, Sayre, PA 18840, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1002\/hep4.1510","article-title":"Nonalcoholic Fatty Liver Disease and Alcoholic Liver Disease Are Major Drivers of Liver Mortality in the United States","volume":"4","author":"Paik","year":"2020","journal-title":"Hepatol. 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