P2.040: Choking Death Prevalence

Background: Historically, specific emphasis has been placed on prevention of choking throughout the process of solid food introduction in infancy, which has informed recommendations for food size, texture, and type introduced to reduce choking risk. In recent years, there has been a shift towards re-evaluating these guidelines, with efforts to diversify the approach to food introduction. In this article we present CDC mortality data to underscore the types (food vs non-food) of foreign objects most frequently fatally aspirated, and related patient demographics including age and sex, in an attempt to inform future strategies for effective prevention.

Methods: This study utilized data from the CDC WONDER Online Database spanning from 2018 to 2023. Choking-related deaths were stratified by age, type of foreign body aspirated, and sex. Mortality rates associated with aspirated food and non-food foreign bodies were compared across different age groups, ranging from less than 1 year to 100+ years. A focused analysis was conducted for the age range of 1-5 years, with further comparison by specific year of age within this group.

Results: We examined choking mortality rates for three main age groups, infancy ( < 1 year old), childhood ( < 1- 5 years old), and total life span ( < 1 - 100+ years old). Within the first year of life, mortality from choking on objects was significantly higher than that from choking of food (p < 0.05). Infants within the recommended period of food introduction (4 months-11 months) had significantly lower mortality rates from choking for both food and non-food objects compared to infants as a whole (birth-1year). Choking related mortality for aspirated food peaks at 1 year of age and is significantly higher than for aspirated food during infancy or toddlerhood 2 years and beyond. Both food and object choking rates decline significantly from infancy through age 3, but stabilize between 3 and 5 years old. The highest rate of food or object related choking deaths occur from 85-89 years old. Food and object related choking deaths have a male predominance at all ages.

Conclusion: This study demonstrated several unexpected trends in choking mortality including a higher rate of infant mortality due to object-related choking compared to food-related choking during the first year of life. It isn’t until after one year of age that choking on food becomes more common than choking on objects, which is often outside of the period of close monitoring that comes with solid food introduction. CDC data also indicates that choking remains a concern throughout life, increasing in incidence with age and peaking between 65 and 90 years of age. The analysis consistently identified a male predominance in choking-related mortality for both food and non-food objects.