Abstract / Summary
Background Thoracic trauma is highly lethal relative to its incidence, yet long-term national mortality trends are poorly described. Methods Thoracic injury deaths (ICD-10 S20-S29) among decedents of all ages were extracted from CDC WONDER Multiple Cause of Death data, 1999 to 2025, by sex, race/ethnicity, Census region, urban/rural status, and state. Joinpoint regression estimated annual percent changes (APC) in age-adjusted mortality rates (AAMR); ARIMA models projected rates to 2040. Results Thoracic trauma appeared on 449,640 death certificates, 74.5% among men. The overall AAMR fell from 7.1 to 3.8 per 100,000 through three declining segments (APC -2.30%, p=0.006; -6.82%, p=0.001; -1.13%, p=0.024), a rise from 4.3 in 2018 to 4.9 in 2021 (APC 3.89%, p=0.007), and a final fall to 2025 (APC -6.01%, p<0.001). Men had about three times the AAMR of women (11.1 to 5.7 versus 3.5 to 1.9; final APC -6.89%, p<0.001 and -3.72%, p=0.009). Pooled AAMRs were highest in American Indian or Alaska Native (8.6) and Black (8.3) individuals and lowest in Asian or Pacific Islander individuals (1.8); the 2018 to 2021 rise was steepest in Black individuals (APC 9.28%, p=0.002). In 2025 the Midwest had the highest regional AAMR (4.7) and the Northeast the lowest (2.6), with significant final declines in all regions (p<0.05). Non-metropolitan counties had nearly twice the metropolitan rate (11.1 to 6.2 versus 6.3 to 3.6). State rates ranged from 2.3 (Hawaii) to 11.6 (Mississippi, Wyoming). Projections to 2040 show continued overall decline but the highest rates in American Indian or Alaska Native (6.2) and Black (5.5) individuals. Conclusions Thoracic trauma mortality fell by nearly half from 1999 to 2025, interrupted during 2018 to 2021 by the pandemic-era surge in traffic fatalities. Persisting disparities among Black, American Indian or Alaska Native, and rural populations warrant targeted improvements in rural trauma access, equitable triage, and road safety.