Upward trend in PE-related mortality in young, middle-aged US adults in recent years

New data suggest that the decreasing trend of pulmonary embolism-related mortality in North America slowed after 2006 among young and middle-aged adults in the United States and plateaued among older adults.

In Canada, mortality related to PE declined from 2000 and 2017, but the decline slowed in all age groups after 2006, researchers reported in Lancet Respiratory Medicine.

“Our findings highlight the need for continued efforts to ensure optimal prevention, early detection and treatment of PE on a population level, as well as within age-specific, sex-specific and race-specific groups characterized by substantial PE-related mortality,” Stefano Barco, MD, research group leader at the Center for Thrombosis and Hemostasis at the University Medical Center Mainz, Germany, and staff physician at the Clinic of Angiology at the University Hospital Zurich, Switzerland, and colleagues wrote.

The researchers analyzed trends in PE-related mortality in the United States and Canada using data from the WHO Mortality Database and the Multiple Cause of Death database produced by the CDC Division of Vital Statistics.

“PE-related mortality is decreasing in Europe. However, time trends in the [U.S.] and Canada remain uncertain because the most recent analyses of PE-related mortality were published in the early 2000s,” Barco and colleagues wrote.

In the United States, researchers reported a decline in the age-standardized annual mortality rate with PE as the underlying cause, from six deaths per 100,000 population (95% CI, 5.9-6.1) in 2000 to 4.4 deaths per 100,000 population (95% CI, 4.3-4.5) in 2006. This decrease continued to 4.1 deaths per 100,000 population (95% CI, 4-4.2) for women in 2017. In men, the decrease plateaued at 4.5 deaths per 100,000 population (95% CI, 4.4-4.7) in 2017.

PE-related mortality increased after 2006 among adults aged 25 to 64 years. The median age at death from PE decreased from 73 years in 2000 to 68 years in 2018. During this period, there was an increase in the prevalence of cancer, respiratory diseases and infections as contributing causes of PE-related mortality in all age groups, according to the study.

The annual age-standardized PE-mortality rate was up to 50% higher in Black adults in the U.S. compared with white adults.

In Canada, researchers reported a decline in the age-standardized annual mortality rate with PE as the underlying cause, from 4.7 deaths per 100,000 population (95% CI, 4.4-5) in 2000 to 2.6 deaths per 100,000 population (95% CI, 2.4-2.8) in 2017. After 2006, there was a steady slow in this decline for all ages and sexes, the researchers reported.

“Additional research is needed to understand the root cause of the increase in PE-related mortality among young and middle-aged adults in the USA and the plateau in its decline in Canada.

“The overall decrease might reflect improvements in prophylaxis and treatment of PE or overdiagnosis of nonfatal PE, whereas the differences across age groups might reflect increasing inequities in the exposure to behavioral risk factors and barriers to access to health care among young and middle-aged adults, the differences in health care policies, or a selective decline in autopsy and hence underdiagnosis of PE in patients aged 65 years and older and, particularly, in those aged 80 years and older. PE should be included in estimates of global mortality to support these efforts to ensure optimal prevention, early detection and treatment,” the researchers wrote.