Temporal Trends in Lower Respiratory Infection Mortality in Ecuador, 2012-2022

Lower respiratory infections (LRIs) are responsible for significant morbidity and mortality in Ecuador; however, evidence to support prevention strategies is limited. This study aimed to identify age-specific trends, spatial patterns, and sociodemographic risk factors of LRI mortality in Ecuador between 2012-2022, utilizing national mortality data sourced from the Ecuadorian National Institute for Statistics and Censuses (INEC). Age-sex-specific trend analysis was performed using Joinpoint regression. LRI age-standardized mortality rates (ASMRs) were mapped by province of death, and percentage change was calculated between 2012 and 2019. Multivariable logistic regression was performed to assess risk factors pre- and post-2020. A change in trend in LRI mortality rate, from a decreasing trend to a marginal increasing trend, was identified for both genders in children aged 0-4 and 5-15 years. There were significant increasing trends for males (2014-2019 APC: 2.21%, 95% CI: 0.57, 6.70) and females (2016-2019 APC: 4.62%, 95% CI: 0.84, 10.58) aged ≥ 70 years. From 2012 to 2019, the highest average LRI ASMR was in Guayas (30.90 deaths per 100,000 inhabitants), and the greatest percentage increase was observed in Orellana (419.54%). Before 2020, LRI mortality, compared to deaths of other causes, was significantly associated with sex, age, education, ethnicity, place of death and climate region, with major shifts post COVID-19 pandemic.