# Temporal Trends in Lower Respiratory Infection Mortality in Ecuador, 2012–2022

## TL;DR

This study examines how lower respiratory infection deaths in Ecuador changed from 2012 to 2022, focusing on age groups, regions, and risk factors.

## Contribution

The study provides new insights into age-specific and regional trends in LRI mortality in Ecuador, including shifts post-COVID-19.

## Key findings

- LRI mortality rates increased in children aged 0–15 and older adults aged ≥70 years after a period of decline.
- Guayas had the highest average LRI mortality rate, while Orellana saw the largest percentage increase.
- Risk factors for LRI mortality changed significantly after the start of the COVID-19 pandemic.

## Abstract

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.