Analysis of contemporary mortality trends in pulmonary embolism, United States, 1999-2020

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 evidencebased and culturally competent public health intervention efforts.