Time Trends in Pulmonary Embolism Mortality Rates in the United States, 1999 to 2018

Abstract

Background Although historical trends before 1998 demonstrated improvements in mortality caused by pulmonary embolism (PE), contemporary estimates of mortality trends are unknown. Therefore, our objective is to describe trends in death rates caused by PE in the United States, overall and by sex‐race, regional, and age subgroups. Methods and Results We used nationwide death certificate data from Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research to calculate age‐adjusted mortality rates for PE as underlying cause of death from 1999 to 2018. We used the Joinpoint regression program to examine statistical trends and average annual percent change. Trends in PE mortality rates reversed after an inflection point in 2008, with an average annual percent change before 2008 of −4.4% (−5.7, −3.0, P <0.001), indicating reduction in age‐adjusted mortality rates of 4.4% per year between 1999 and 2008, versus average annual percent change after 2008 of +0.6% (0.2, 0.9, P <0.001). Black men and women had approximately 2‐fold higher age‐adjusted mortality rates compared with White men and women, respectively, before and after the inflection point. Similar trends were seen in geographical regions. Age‐adjusted mortality rates for younger adults (25–64 years) increased during the study period (average annual percent change 2.1% [1.6, 2.6]) and remained stable for older adults (>65 years). Conclusions Our study findings demonstrate that PE mortality has increased over the past decade and racial and geographic disparities persist. Identifying the underlying drivers of these changing mortality trends and persistently observed disparities is necessary to mitigate the burden of PE‐related mortality, particularly premature preventable PE deaths among younger adults (<65 years).

Feasibility of anticoagulation using low molecular-weight heparin during catheter-directed thrombolysis for lower extremity deep venous thrombosis

“…A recyclable inferior vena cava filter (OptEase (Cordis, USA) or Celect (Cook, USA)) was generally recommended for patients with high risk of PE [ 1 ]:. previous PE [ 2 ]; planning to accept pneumatic compression treatment. The filter was implanted via the healthy femoral or jugular vein before CDT, and it was removed when the CDT ended.…”

“…For patients who experienced complete thrombolysis, CDT was discontinued. For patients who experienced partial thrombolysis, CDT was discontinued if patients met at least one criterion [ 1 ]: serum level of D-dimer exhibited no significant change [ 2 ]; complications with bleeding [ 3 ]; ultrasound or venography indicated no improvement. During, the catheter position might be adjusted according to thrombolytic outcome.…”

“…Deep venous thrombosis (DVT) is a common disease with an incidence of approximately 1 ~ 2 per 1000 persons per year [ 1 ]. It is one of the major causes of pulmonary embolism (PE), which led to nearly 1 60,000 deaths in American during the period from 1998 to 2018 [ 2 ].…”

“…Yonghui Li and Junwei Wang [ 1 ]: the conception and design of the study, acquisition of data, analysis, and interpretation of data [ 2 ], drafting the article and revising it for important intellectual content [ 3 ], final approval of the version to be submitted. Rongzhou He [ 1 ]: acquisition of data, analysis, and interpretation of data [ 2 ], article revision [ 3 ], final approval of the version to be submitted. Junmeng Zheng [ 1 ]: acquisition and analysis of data [ 2 ], article revision [ 3 ], final approval of the version to be submitted.…”

Clinical significance of subsegmental pulmonary embolism: An ongoing controversy

“…The overall mortality associated with PEs has remained largely unchanged in the first decade after introduction of CTPA, despite a steep increase in PE incidence during this period 1 . Although nationwide death certificate data of the United States suggests an increase in the rate of deaths caused by PE since 2008, 7 findings from before 2008 implicate that the extra PE diagnosed with multidetector CTPA compared to less sensitive diagnostic modalities represent in average less severe disease. Accordingly, the smallest clots, that is, SSPEs, may be clinically irrelevant and potentially require a different therapeutic approach than segmental or more central PE 8 .…”