Gender, Racial, and Geographic Disparities in Pulmonary Embolism-related Mortality Nationwide

Rationale: Acute pulmonary embolism (PE) is a leading cause of cardiovascular death. There is limited data on the national mortality trends from PE. Understanding these trends is crucial for addressing the mortality and associated disparities associated with PE. Objectives: to analyze the national mortality trends related to acute PE and determine the overall age-adjusted mortality rate (AAMR) per 100,000 population for the study period and assess changes in AAMR among different genders, races, and geographic locations. Methods: We conducted a retrospective cohort analysis using mortality data of individuals aged 15 years and older with PE listed as the underlying cause of death in the Centers for Disease Control (CDC) and Prevention Wide-Ranging Online Data for Epidemiologic Research database from January 2006 to December 2019. These data are produced by the National Center for Health Statistics. Results: A total of 109,992 PE-related deaths were noted in this dataset nationwide between 2006 and 2019. Of these, women constituted 60,113 (54.7%). The AAMR per 100,000 was not significantly changed from 2.84 in 2006 to 2.81 in 2019 (Average annual percentage change (AAPC) 0.2, 95% CI -0.1-0.5, p=0.15). AAMR increased for men throughout the study period compared to women (AAPC 0.7 for men, 95% CI 0.3-1.2, p=0.004 vs. AAPC -0.4 for women, 95% CI -1.1-0.3, p=0.23, respectively). Similarly, AAMR for PE increased for Blacks compared Whites, from 5.18 to 5.26 (AAPC 0.4, 95% CI 0.0-0.7, p=0.05) and 2.82 to 2.86 (APC 0.0, 95% CI -0.6-0.6, p=0.99), respectively. Similarly, AAMR for PE was higher in rural areas compared to micropolitan and large metropolitan areas during the study period (4.07 {95% CI: 4.02-4.12} vs. 3.24 {95% CI: 3.21-3.27} vs. 2.32 {95% CI: 2.30-2.34}, respectively). Conclusion: Pulmonary embolism mortality remains high and unchanged over the past decade, and enduring gender, racial and socio-economic disparities persist in PE. Targeted efforts to decrease PE mortality and address such disparities are needed.