Abstract
Background
A contemporary and comprehensive examination of mortality trends in pulmonary embolism
(PE) is needed for the United States (US), as previous studies were either based on
preceding data or limited to specific demographic subgroups. We aimed to assess the
trends in PE deaths by age, sex, race/ethnicity, and census region in the US from
1999 through 2020.
Methods
We analyzed national mortality data using the CDC WONDER database. PE deaths were
identified using the ICD-10 Code- I-26. Age adjusted mortality rates (AAMR) were abstracted
by age, sex, race/ethnicity, and census region. Temporal trends were assessed using
five-year moving averages and Joinpoint regression models. Annual percentage changes
(APC) in AAMR were estimated using Monte Carlo Permutation, and 95 % confidence intervals
using the Parametric Method.
Results
Overall mortality trends have stabilized since 2009 (APC = 0.6; 95 % CI: −0.3, 1.6),
as were trends among Non-Hispanic Whites (APC = 0.6; 95 % CI: −0.2, 1.4), Non-Hispanic
Blacks (APC = 0.7; 95 % CI: −0.2, 1.6), and Hispanics (APC = 1.4; 95 % CI: −0.7, 3.6).
AAMR declined by 1.7 % per year (95 % CI: −2.8, −0.7) among Asians/Pacific Islanders
and by 1.4 % per year (95 % CI: −2.8, −0.0) among American Indians/Alaska Natives,
from 1999 to 2020. Contemporary trends have increased among males (APC = 1.0; 95 %
CI: 0.2, 1.9), persons below 65 years of age (APC = 18.6; 95 % CI: 18.6, 18.6; APC = 2.3;
95 % CI: 1.4, 3.1), and persons from the Northeastern (APC = 1.0; 95 % CI: 0.1, 2.0)
and Western regions (APC = 1.6; 95 % CI: 0.7, 2.6).
Conclusions
The decline in PE mortality recorded from 1999 through the mid-2000s has not been
sustained in the last decade-overall trends have stabilized since 2009. However, there
were differences by age, sex, race/ethnicity, and the US census region, with some
subgroups demonstrating stationary, increasing, or declining trends. Further studies
should examine the drivers of differential trends in the US population to inform evidence-based
and culturally competent public health intervention efforts.
Abbreviations:
AAMR (age-adjusted mortality rate), AAPC (average annual percentage change), APC (annual percentage change), CDC (Centers for Disease Control and Prevention), CI (confidence interval), ICD-10 (International Classification of Diseases Codes, 10th Revision), PE (pulmonary embolism), US (United States), WONDER (Wide-ranging Online Data for Epidemiologic Research)Keywords
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Article info
Publication history
Published online: January 18, 2023
Accepted:
January 4,
2023
Received in revised form:
November 22,
2022
Received:
August 3,
2022
Identification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
