COVID Pandemic Drove Up Deaths From Respiratory Distress and Sepsis – Medscape

Analysis of Sepsis and ARDS Mortality Trends in the U.S. (1999-2023) and Their Alignment with Sustainable Development Goals

Introduction: Health Outcomes and Global Goals

A recent study presented at the American College of Chest Physicians (CHEST) 2025 Annual Meeting examined mortality trends for patients with coexisting acute respiratory distress syndrome (ARDS) and sepsis in the United States from 1999 to 2023. The findings provide critical insights into public health challenges and resilience, directly aligning with the United Nations’ Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities).

Mortality Trends and Implications for SDG 3: Good Health and Well-being

The study’s primary findings on mortality rates highlight progress, setbacks, and the critical importance of robust health systems, a core tenet of SDG 3. The research, utilizing data from CDC death certificates, identified a distinct timeline of mortality rates.

1. Pre-Pandemic Period (1999-2019): The age-adjusted mortality rate (AAMR) for individuals with both conditions demonstrated a positive trend, decreasing from 1.9 to 1.2. This decline suggests advancements in clinical management and care strategies, contributing to the SDG 3 target of reducing premature mortality.
2. COVID-19 Pandemic Period (2020-2021): The pandemic caused a dramatic reversal of this progress. The AAMR spiked to 2.8 in 2020 and 3.9 in 2021, representing a 44.2% increase from pre-pandemic levels. This surge underscores the vulnerability of health systems to global health crises, a key concern addressed in SDG Target 3.d, which calls for strengthening capacity for early warning and management of global health risks.
3. Post-Pandemic Period (2022-2023): A rapid 45.1% decrease in the AAMR to 1.3 was observed, returning mortality rates to pre-pandemic levels. This recovery reflects the impact of vaccination efforts and improved management protocols, reinforcing the effectiveness of public health interventions in achieving good health outcomes.

Disparities in Health Outcomes: A Challenge to SDG 10 (Reduced Inequalities)

The study revealed significant disparities in mortality, exposing systemic inequalities that SDG 10 aims to eliminate. The burden of increased mortality during the pandemic was not distributed equally across the population.

• Racial and Ethnic Disparities: The increase in AAMR during the COVID-19 era was most pronounced among minority groups, directly challenging the objective of SDG 10 to ensure equal opportunity and reduce inequalities of outcome.
  • Non-Hispanic Asian individuals: 66.1% increase
  • Hispanics: 61.0% increase
  • Non-Hispanic Blacks: 41.0% increase
  • Non-Hispanic American Indians: 40.8% increase
  • Non-Hispanic Whites: 34.8% increase
• Geographic Disparities: Access to healthcare resources, a critical factor in health equity, was highlighted by geographic differences in mortality spikes.
  • Urban vs. Rural: Urban areas experienced a greater AAMR increase (47.4%) compared to rural areas (36.1%), pointing to vulnerabilities in densely populated community health infrastructures.
  • Regional Differences: The western U.S. recorded the highest increase in AAMR (53.0%), indicating regional variations in healthcare system capacity and response.

Conclusion: A Call for Action Aligned with Global Development Goals

The study’s conclusions emphasize that the post-pandemic decline in mortality from ARDS and sepsis necessitates a renewed focus on building resilient and equitable health systems. The findings advocate for specific actions that are fundamental to achieving the Sustainable Development Goals.

• Bolster Pandemic Preparedness: In line with SDG 3, strengthening national and global capacity for managing health risks is paramount to prevent future mortality spikes.
• Implement Targeted Interventions: To advance SDG 10, interventions must be designed to protect vulnerable and high-risk populations, addressing the racial and geographic disparities identified.
• Improve Healthcare Access: Ensuring equitable access to critical care resources is essential for reducing inequalities in health outcomes, a core principle of both SDG 3 and SDG 10.
• Optimize Sepsis Management: Continued improvement in clinical protocols for conditions like sepsis and ARDS contributes directly to the SDG 3 target of reducing premature mortality from non-communicable diseases and promoting well-being.

Analysis of SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The entire article is centered on health issues, specifically mortality rates associated with acute respiratory distress syndrome (ARDS), sepsis, and the COVID-19 pandemic. It discusses disease prevalence, mortality trends, and the need for better management and pandemic preparedness, all of which are core components of SDG 3.
• SDG 10: Reduced Inequalities: The article explicitly highlights significant disparities in health outcomes among different demographic and geographic groups. It details how the increase in mortality rates during the pandemic varied by race, ethnicity, sex, and location (urban vs. rural), directly addressing the theme of inequality in health.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.4: Reduce premature mortality from non-communicable diseases. Although sepsis and ARDS are often triggered by communicable diseases like COVID-19, this target’s focus on reducing premature mortality through treatment and management is directly relevant. The article’s analysis of age-adjusted mortality rates (AAMR) and the call to “optimize sepsis management to reduce mortality” align with this goal.
2. Target 3.d: Strengthen the capacity for early warning, risk reduction and management of national and global health risks. The article’s conclusion emphasizes the “urgent need to bolster pandemic preparedness” following the spike in deaths during the COVID-19 pandemic. This directly reflects the goal of improving systems to manage major health crises.
3. Target 10.2: Promote the inclusion of all, irrespective of age, sex, race, ethnicity, etc. The study’s findings show that the impact of the pandemic on mortality was not uniform. The article states the “COVID-era increase in AAMR was highest in non-Hispanic Asian individuals (66.1%), followed by Hispanics (61.0%), non-Hispanic Blacks (41.0%)”. It also notes differences between men and women. This data highlights inequalities in health outcomes, which this target aims to address.
4. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome. The article connects worse health outcomes to a lack of access to healthcare. It quotes an expert saying, “those who are less likely to be able to readily access critical care are more likely to die from these conditions.” This points to an inequality of outcome based on geographic and socioeconomic factors, which this target seeks to eliminate.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicator: Age-Adjusted Mortality Rate (AAMR). The article uses AAMR as its primary metric to track deaths from ARDS and sepsis over time. It provides specific data points, such as the AAMR decreasing “from 1.9 to 1.2 between 1999 and 2019” and spiking “to 3.9 in 2021.” This is a direct indicator for measuring progress on Target 3.4.
2. Indicator: Mortality rates disaggregated by demographic and geographic factors. The article provides several disaggregated statistics that serve as indicators for Target 10.2 and 10.3. These include:
   • By Sex: “men had slightly higher AAMRs than women (1.8 vs 1.4).”
   • By Race/Ethnicity: The percentage increase in AAMR is broken down for “non-Hispanic Asian individuals (66.1%)”, “Hispanics (61.0%)”, “non-Hispanic Blacks (41.0%)”, and others.
   • By Location: The article compares the AAMR increase in “Urban areas” versus “rural areas (47.4% vs 36.1%)” and across different US regions.
3. Indicator: Pandemic Impact on Mortality. The article quantifies the impact of the COVID-19 pandemic, noting a “44.2% increase from pre-pandemic levels” in AAMR. The subsequent “rapid 45.1% decrease” to a baseline “same as pre-COVID” serves as an indicator of health system resilience and the effectiveness of responses (like vaccination and management advances), which is relevant to Target 3.d.

4. Table of SDGs, Targets, and Indicators

Source: medscape.com