Trends in Choking-Related Deaths After Introduction of the Heimlich Maneuver

To evaluate national mortality trends associated with choking before and after the introduction of the Heimlich maneuver in 1974.

We analyzed CDC Multiple Cause-of-Death data from 1970 to 2021 to identify deaths in which choking was the primary cause, using ICD-8, -9, and -10 codes. Deaths in which choking was coded only as a contributing cause were excluded. Mortality rates were stratified by age (15-64 and ≥ 65); for data from 1979 to 2021, deaths were additionally stratified by location (inpatient vs. outpatient) within each age stratum. Temporal trends were assessed using Joinpoint regression, with annual percentage change (APC) as the primary outcome.

Among individuals aged 15-64, choking mortality increased from 1970 to 1975 (APC +2.45%) then declined significantly from 1975 to 1985 (APC -5.15%) and continued to decrease through 2021. Outpatient deaths in this age group declined consistently from 1979 to 2021. Among adults ≥ 65 years, no sustained mortality reduction was observed; inpatient deaths in this group fluctuated with alternating periods of increase and decrease.

A sustained decline in choking-related mortality among nonelderly adults coincided temporally with the introduction and widespread adoption of the Heimlich maneuver, particularly in outpatient settings. No corresponding reduction was observed among older adults in inpatient settings. These findings are consistent with a population-level benefit of the maneuver in community settings, though causality cannot be established from these data. Tailored preventive strategies are needed for high-risk elderly populations.