Division of Hematology/Oncology Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL.
Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL.
J Am Heart Assoc. 2020 Sep;9(17):e016784. doi: 10.1161/JAHA.120.016784. Epub 2020 Aug 17.
Background Although historical trends before 1998 demonstrated improvements in mortality caused by pulmonary embolism (PE), contemporary estimates of mortality trends are unknown. Therefore, our objective is to describe trends in death rates caused by PE in the United States, overall and by sex-race, regional, and age subgroups. Methods and Results We used nationwide death certificate data from Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research to calculate age-adjusted mortality rates for PE as underlying cause of death from 1999 to 2018. We used the Joinpoint regression program to examine statistical trends and average annual percent change. Trends in PE mortality rates reversed after an inflection point in 2008, with an average annual percent change before 2008 of -4.4% (-5.7, -3.0, <0.001), indicating reduction in age-adjusted mortality rates of 4.4% per year between 1999 and 2008, versus average annual percent change after 2008 of +0.6% (0.2, 0.9, <0.001). Black men and women had approximately 2-fold higher age-adjusted mortality rates compared with White men and women, respectively, before and after the inflection point. Similar trends were seen in geographical regions. Age-adjusted mortality rates for younger adults (25-64 years) increased during the study period (average annual percent change 2.1% [1.6, 2.6]) and remained stable for older adults (>65 years). Conclusions Our study findings demonstrate that PE mortality has increased over the past decade and racial and geographic disparities persist. Identifying the underlying drivers of these changing mortality trends and persistently observed disparities is necessary to mitigate the burden of PE-related mortality, particularly premature preventable PE deaths among younger adults (<65 years).
背景 尽管 1998 年之前的历史趋势表明肺栓塞（PE）死亡率有所改善，但目前尚不清楚死亡率趋势的当代估计值。因此，我们的目的是描述美国 PE 死亡率的趋势，包括总体趋势以及按性别-种族、地区和年龄分组的趋势。
方法和结果 我们使用疾病控制与预防中心广域在线流行病学研究数据中心的全国性死亡证明数据，计算了 1999 年至 2018 年作为死亡根本原因的 PE 的年龄调整死亡率。我们使用 Joinpoint 回归程序检查统计趋势和平均年变化百分比。PE 死亡率趋势在 2008 年的拐点后发生逆转，2008 年前的平均年变化百分比为-4.4%（-5.7，-3.0，<0.001），表明 1999 年至 2008 年期间，年龄调整死亡率每年降低 4.4%，而 2008 年后的平均年变化百分比为+0.6%（0.2，0.9，<0.001）。在拐点前后，黑人和女性的年龄调整死亡率分别比白人和女性高约 2 倍。在地理区域也观察到类似的趋势。在研究期间，年轻成年人（25-64 岁）的年龄调整死亡率增加（平均年变化百分比为 2.1%[1.6，2.6]），而老年人（>65 岁）的死亡率保持稳定。
结论 我们的研究结果表明，过去十年中 PE 死亡率有所上升，种族和地理差异仍然存在。确定这些不断变化的死亡率趋势和持续观察到的差异的根本驱动因素对于减轻与 PE 相关的死亡率负担，特别是减轻年轻成年人（<65 岁）的过早可预防的 PE 死亡至关重要。
