Pulmonary Embolism-Attributable Mortality in Patients With Atherosclerotic Cardiovascular Disease in the United States from 2010 to 2023.
Abstract
Background
Patients with atherosclerotic cardiovascular disease (ASCVD) are at increased risk of pulmonary embolism (PE) and related mortality, yet contemporary US trends remain incompletely defined. We examined PE-attributable mortality from 2010 to 2023 among patients with ASCVD, stratified by age, sex, race, ethnicity, urbanization, and region.
Methods
We used the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research data (2010-2023) to assess PE-attributable mortality among patients with ASCVD aged ≥15 years using age-adjusted mortality rates. Concurrent trends in age-adjusted ASCVD prevalence and risk factors were evaluated using NHANES (National Health and Nutrition Examination Survey). Age-adjusted mortality rates were analyzed with Joinpoint regression to estimate average annual percentage change (95% CI), and trends in NHANES were assessed using linear models.
Results
From 2010 to 2023, 152 386 US patients with ASCVD aged ≥15 years (80 015 male, 72 371 female) died from PE. PE-attributable AAMR rose from 3.62 to 4.96 per 100 000 (annual percentage change +3.1%; P<0.001), with a modest increase from 2010 to 2018 (annual percentage change +0.7%, P=0.003) and a sharp rise from 2018 to 2023 (annual percentage change +12.8%, P<0.001). Age-adjusted mortality rate was highest in non-Hispanic/non-Latinx Black American individuals, and American Indian/Alaska Native and Hispanic/Latinx populations had the steepest increases. Adults <65 years, rural areas, and the Western United States showed disproportionate rises, whereas the South had the highest absolute deaths. Such trends paralleled increasing ASCVD prevalence, which was driven by hypertension, obesity, diabetes, and chronic kidney disease.
Conclusions
PE-attributable mortality among US patients with ASCVD rose from 2010 to 2023 particularly among young-to-middle-aged adults, socioeconomically isolated ethnic and racial groups, and Western residents.