Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany; Clinic of Angiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.
Lancet Respir Med. 2021 Jan;9(1):33-42. doi: 10.1016/S2213-2600(20)30417-3. Epub 2020 Oct 12.
Pulmonary embolism (PE)-related mortality is decreasing in Europe. However, time trends in the USA and Canada remain uncertain because the most recent analyses of PE-related mortality were published in the early 2000s.
For this retrospective epidemiological study, we accessed medically certified vital registration data from the WHO Mortality Database (USA and Canada, 2000-17) and the Multiple Cause of Death database produced by the Division of Vital Statistics of the US Centers for Disease Control and Prevention (CDC; US, 2000-18). We investigated contemporary time trends in PE-related mortality in the USA and Canada and the prevalence of conditions contributing to PE-related mortality reported on the death certificates. We also estimated PE-related mortality by age group and sex. A subgroup analysis by race was performed for the USA.
In the USA, the age-standardised annual mortality rate (PE as the underlying cause) decreased from 6·0 deaths per 100 000 population (95% CI 5·9-6·1) in 2000 to 4·4 deaths per 100 000 population (4·3-4·5) in 2006. Thereafter, it continued to decrease to 4·1 deaths per 100 000 population (4·0-4·2) in women in 2017 and plateaued at 4·5 deaths per 100 000 population (4·4-4·7) in men in 2017. Among adults aged 25-64 years, it increased after 2006. The median age at death from PE decreased from 73 years to 68 years (2000-18). The prevalence of cancer, respiratory diseases, and infections as a contributing cause of PE-related death increased in all age categories from 2000 to 2018. The annual age-standardised PE-related mortality was consistently higher by up to 50% in Black individuals than in White individuals; these rates were approximately 50% higher in White individuals than in those of other races. In Canada, the annual age-standardised mortality rate from PE as the underlying cause of death decreased from 4·7 deaths per 100 000 population (4·4-5·0) in 2000 to 2·6 deaths per 100 000 population (2·4-2·8) in 2017; this decline slowed after 2006 across age groups and sexes.
After 2006, the initially decreasing PE-related mortality rates in North America progressively reached a plateau in Canada, while a rebound increase was observed among young and middle-aged adults in the USA. These findings parallel recent upward trends in mortality from other cardiovascular diseases and might reflect increasing inequalities in the exposure to risk factors and access to health care.
None.
在欧洲，与肺栓塞（PE）相关的死亡率正在下降。然而，美国和加拿大的时间趋势仍不确定，因为最近对与 PE 相关的死亡率的分析发表于 21 世纪初。
在这项回顾性流行病学研究中，我们从世界卫生组织死亡率数据库（美国和加拿大，2000-17 年）和美国疾病控制与预防中心（CDC）的死因多原因数据库（美国，2000-18 年）获取了经医学认证的人口登记数据。我们调查了美国和加拿大与 PE 相关的死亡率的当代时间趋势，以及在死亡证明上报告的导致与 PE 相关的死亡率的疾病的流行情况。我们还按年龄组和性别估算了与 PE 相关的死亡率。对美国进行了按种族的亚组分析。
在美国，年龄标准化的年死亡率（PE 为根本死因）从 2000 年的每 10 万人中有 6.0 例死亡（95%CI 5.9-6.1）降至 2006 年的每 10 万人中有 4.4 例死亡（4.3-4.5）。此后，女性的死亡率持续下降，至 2017 年为每 10 万人中有 4.1 例死亡（4.0-4.2），而男性的死亡率则在 2017 年稳定在每 10 万人中有 4.5 例死亡（4.4-4.7）。在 25-64 岁的成年人中，这一比例在 2006 年后有所上升。死于 PE 的患者的中位年龄从 73 岁降至 68 岁（2000-18 年）。导致与 PE 相关的死亡的癌症、呼吸疾病和感染的患病率在所有年龄组中从 2000 年至 2018 年都有所增加。黑人个体的年龄标准化与 PE 相关的死亡率始终比白人个体高 50%左右；白人个体的死亡率比其他种族的个体高约 50%。在加拿大，2000 年每 10 万人中有 4.7 例死亡（4.4-5.0），是 PE 作为根本死因的年死亡率，至 2017 年降至每 10 万人中有 2.6 例死亡（2.4-2.8）；此后，各年龄段和性别的死亡率都有所减缓。
2006 年后，北美地区与 PE 相关的死亡率最初的下降趋势逐渐趋于平稳，而美国的年轻和中年人群的死亡率则出现反弹。这些发现与最近心血管疾病死亡率的上升趋势相吻合，可能反映了风险因素暴露和获得医疗保健方面的不平等日益加剧。
在美国和加拿大，与 PE 相关的死亡率在 21 世纪初开始下降，但在 2006 年后，加拿大的死亡率趋于平稳，而美国的年轻和中年人群的死亡率则出现反弹。这些发现与最近其他心血管疾病死亡率的上升趋势相吻合，可能反映了风险因素暴露和获得医疗保健方面的不平等日益加剧。
无。
