Justification :
Acute pulmonary embolism (PE) is one of the leading causes of cardiovascular death. There are limited data on national PE mortality trends. Understanding these trends is crucial to addressing mortality and disparities associated with PD.
Goals:
To analyze 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 evaluate changes in AAMR among different genders, races, and geographic locations.
Methods:
We performed a retrospective cohort analysis using mortality data from persons aged 15 years or older with PD listed as an underlying cause of death in the Centers for Disease Control’s Wide-ranging Online Data for Epidemiologic Research database ( CDC) and Prevention from January 2006 to December 2019. These data are prepared by the National Center for Health Statistics. Results.
In this data set, a total of 109,992 PD-related deaths were observed nationwide between 2006 and 2019. Of them, 60,113 (54.7%) were women. AAMR per 100,000 did not change significantly 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 ).
Overall age-adjusted mortality (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, the AAMR for PE increased in blacks compared to whites, from 5.18 to 5.26 (AAPC 0.4, 95% CI: 0.0-0.7, p=0.05 ) and from 2.82 to 2.86 (APC 0.0, 95% CI: -0.6-0.6, p=0.99), respectively.
Similarly, the AAMR for PD 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 gender, racial, and socioeconomic disparities in PE persist. Specific efforts are needed to decrease PE mortality and address such disparities. |
Comments
Over the past 20 years, treatments for pulmonary embolism have advanced tremendously. Several new therapies have been developed along with the widespread adoption of emergency response teams for this condition, which is characterized by a blockage of the arteries in the lungs often caused by a blood clot.
Despite these innovations, a Michigan Medicine study finds that the death rate from pulmonary embolism remains high and unchanged in recent years, most often killing men, black patients and people in rural areas.
The results are published in Annals of the American Thoracic Society .
"These findings are surprising and contradictory to advances in the care of patients with pulmonary embolism over the past decade, as well as other studies suggesting a downward trajectory in mortality from other major causes of cardiovascular death," said lead author , Mohamed Zghouzi, MD who was a vascular medicine fellow at the University of Michigan Health Frankel Cardiovascular Center at the time the work was performed.
Researchers analyzed more than 100,000 pulmonary embolism-related deaths between 2006 and 2019 using national data from the Centers for Disease Control and Prevention.
They found that the death rate from pulmonary embolism did not change significantly from 2.8 deaths per 100,000 people over the course of the decade. However, the death rate increased significantly among men, as well as among black patients, who were almost twice as likely to die from this condition compared to white patients.
In rural areas, 4 patients per 100,000 died from pulmonary embolism, which is almost double that of large metropolitan areas.
"Seeing a higher incidence of blood clots, including pulmonary embolism, in black populations, patients in rural areas, and those with lower socioeconomic status suggests that social determinants of health play a role in the incidence and outcomes of the venous thromboembolism," said Geoffrey Barnes, M.D., M.Sc., co-author and associate professor of cardiology and internal medicine at the U-M School of Medicine.
Pulmonary embolism is usually caused by deep vein thrombosis, which travels through the body to the lungs. It affects about 900,000 people in the U.S. each year, and between 10 and 30% of people die within a month of diagnosis, according to the American Lung Association.
"These findings highlight the need for increased funding for research focused on the underlying causes of these mortality rates and disparities, as well as for targeted interventions and programs aimed at improving pulmonary embolism outcomes for all patients," Barnes said. .
Additional authors include Hunter Mwansa, MD, Supriya Shore, MD, Syed Nabeel Hyder, MD, Neil Kamdar, Victor M. Moles, MD, James Froehlich, MD, Vallerie V. McLaughlin, MD, Brahmajee Nallamothu, MD, and Vikas Aggarwal , MD, all of Michigan Medicine at the time of the work, Timir K. Paul, MD, Ph.D., of the University of Tennessee at Nashville, Kenneth Rosenfield, MD, of Massachusetts General Hospital, and Jay Giri, MD, from the University of Pennsylvania.
Funding: BGF – consultancy for Abbott Vascular, Boston Scientific. JG has served on advisory boards and received research funding for the institution from Abiomed, Boston Scientific, Abbott Vascular, and Inari Medical. KR: Consultant/Scientific Advisory Board, Abbott Vascular, Althea Medical, Angiodynamics, Boston Scientific, Penumbra. Board Member and Founder: PERT National Consortium. All other authors have no relevant relationships to disclose.
