PE-related deaths increased through 2020, regardless of COVID-19 status
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In 2020, there was an increase in pulmonary embolism-related mortality not limited only to patients with confirmed SARS-CoV-2 infection, according to a research letter published in the Journal of the American College of Cardiology.
“We observed a substantial increase in the overall PE-related mortality after the pandemic outbreak, which was not limited to deaths with confirmed COVID-19,” Ioannis T. Farmakis, MD, MSc, of the Center for Thrombosis and Hemostasis at the University Medical Center of the Johannes Gutenberg University in Mainz, Germany, and colleagues wrote. “Whether changes in health care, encompassing preventive, medical and logistic measures, may have reduced the excess in PE-related mortality concerning the latest waves is being investigated.”
For this analysis, researchers utilized the CDC’s Mortality – Multiple Cause of Death database to identify all deaths listed as PE-related or COVID-19-related death between 2018-2019 and 2020.
The overall age-adjusted rate of death from PE in 2020 was 12.23 per 100,000 people (95% CI, 12.12-12.35): 10.92 per 100,000 people for PE-related death without COVID-19 plus 1.31 per 100,000 people for PE-related death with COVID-19.
Compared with mortality rates of 9.81 and 9.95 per 100,000 in 2018 and 2019, respectively, these findings translate to a 23.8% increase in deaths from PE in 2020 from the previous years.
In 2020, age-adjusted mortality rate of PE-related deaths without COVID-19 was higher among men compared with women (11.63 per 100,000 people vs. 10.32 per 100,000 people; RR = 1.13; 95% CI, 1.1-1.16), and the difference in PE-related death between men and women was greater among those with COVID-19 (1.72 per 100,000 people vs. 0.97 per 100,000 people; RR = 1.75; 95% CI, 1.63-1.9).
Researchers also observed greater PE-related mortality among Black individuals compared with white individuals, regardless of COVID-19 status.
Moreover, among patients with COVID-19 who died, the proportion with PE was higher among younger patients aged up to 44 years (2.7%) compared with adults aged 45 to 85 years or older (1.4%).
“In 2020, there was an excess mortality for PE, which appeared synchronously with the COVID-19 pandemic waves. COVID-19 contributed as a cause of death in one-half of the excess PE-related deaths,” the researchers wrote. “Nonetheless, a swift increase was observed in PE-related mortality rate without mention of COVID-19 in the death certificates ... which diverges from the mild increase observed in the same population between 2009 and 2018 (approximately 2% per year). We hypothesize that [there were] possible undiagnosed COVID-19 cases, especially in the early phase of the non-COVID-19-related diseases due to resource shortage.”
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