Pulmonary embolism admissions increased during COVID-19 pandemic, surges differed by race
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Key takeaways:
- Pulmonary embolism admission rates in 2023 have not returned to those observed in 2017.
- The rate of pulmonary embolism admissions in 2021 was highest among African American patients vs. white and Asian patients.
SAN DIEGO — Between 2017 and 2023, the highest rate of pulmonary embolism admissions was found in 2021 during the COVID-19 pandemic, according to research presented at the American Thoracic Society International Conference.
“These findings highlight a potential lingering impact of the pandemic, suggesting a continued elevated incidence of pulmonary embolisms,” Anugya Mittal, MD, first-year resident in the internal medicine program at Lewis Katz School of Medicine at Temple University, told Healio.
“The observed racial disparities in incidence rates underscore the importance for clinicians to consider race as a factor when evaluating patients for pulmonary embolisms,” Mittal continued. “This awareness can result in more targeted risk assessment, diagnosis and management strategies, ensuring equitable and effective care for all patients.”
Using the Cosmos electronic health record database, Mittal and colleagues assessed 50,322,725 admissions between January 2017 and October 2023 to evaluate how the rate of admissions with a clinical diagnosis of pulmonary embolism (n = 928,132) changed over time and how they differed between racial groups.
Notably, this trend study included years prior to and during the COVID-19 pandemic, as well as some months after the May 2023 end of COVID-19 public health and national emergencies.
“Numerous studies have observed an uptake in pulmonary embolism cases amid the COVID-19 pandemic,” Mittal said. “The virus exerts direct effects on endothelial cells within the pulmonary microvasculature, thereby activating the coagulation cascade through pro-inflammatory mechanisms such as cytokine activation to result in a hypercoagulable state.”
Of the total number of admissions from 2017, 1.5% were related to pulmonary embolism. Researchers found the highest rate of pulmonary embolism admissions in 2021 at 2.2% of the total admissions for that year. From January 2023 up until October, the rate of pulmonary embolism admissions (1.9%) went down from the peak but was still higher than the 2017 rate.
When divided by race, white patients had nearly identical proportional rates of pulmonary embolism admissions to those outlined above: 1.6% in 2017, 2.2% in 2021 and 1.9% between January and October 2023.
Similar to white patients, researchers observed the highest rate of pulmonary embolism admissions among African American patients in 2021 (2.6%). The rate of these admissions in this patient population started off low in 2017 at 1.7%. By the last year of the study, the rate of pulmonary embolism admissions only slightly dropped from the 2021 peak to 2.3% of the total admissions from that year.
In 2021, the rate of pulmonary embolism admissions among Asian patients “nearly doubled” from that of 2017 (0.561% to 1.1%), Mittal told Healio. Similar to the two other racial groups, the pulmonary embolism admission rate in this patient population went down from the peak in 2023 to 0.936% but was still higher than the rate observed in 2017.
“The observed surge in pulmonary embolisms across varied demographics during the COVID-19 pandemic underscores the prevailing influence of COVID-19-induced proinflammatory states over genetic susceptibilities as this trend was observed in several different groups,” Mittal said.
“Furthermore, the sustained elevation of pulmonary embolism rates post-pandemic beckons further inquiry into lingering health impacts,” she added.
When asked if this study supports findings from previous research in terms of racial differences in pulmonary embolism, Mittal said it did through the observation of “the highest proportional incidence amongst African Americans in contrast to the lowest rates amongst Asians.”
“Pre-pandemic studies have consistently shown that African American patients have the highest pulmonary embolism incidence rates, often associated with poorer outcomes,” she said.
“This finding aligns with findings from studies in Asia where the lower incidence of pulmonary embolisms is thought to be secondary to a lower rate of hereditary thrombophilias,” Mittal added. “Hence, a multitude of factors, encompassing genetics and comorbidities, contribute to racial disparities in pulmonary embolism occurrences.”
In addition to statistical analysis, Mittal noted that continued research on this topic might try to understand the differences found in this trend study.
“Future studies can focus more on understanding the differences between these groups and understanding the rates of pulmonary incidence post-pandemic,” Mittal said. “Preliminarily based off the data from this study, it appears that the overall rates amongst most racial groups have increased.”