Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
Cardiovascular Medicine Division and Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Yale/YNHH Center for Outcomes Research and Evaluation, New Haven, CT, United States.
Thromb Res. 2023 Aug;228:72-80. doi: 10.1016/j.thromres.2023.05.028. Epub 2023 Jun 5.
Population-based data on high-risk pulmonary embolism (PE) mortality trends in the United States (US) are scant.
To assess current trends in US mortality related to high-risk PE over the past 21 years and determine differences by sex, race, ethnicity, age and census region.
Data were extracted from the Centers for Disease Control and Prevention (CDC) Wide-ranging ONline Data for Epidemiologic Research (WONDER) to determine trends in age-adjusted mortality rates (AAMR) per 100,000 people, due to high-risk PE. To calculate nationwide annual trends, we assessed the average (AAPC) and annual percent change (APC) with relative 95 % confidence intervals (CIs) using Joinpoint regression.
Between 1999 and 2019, high-risk PE was listed as the underlying cause of death in 209,642 patients, corresponding to an AAMR of 3.01 per 100,000 people (95 % CI: 2.99 to 3.02). AAMR from high-risk PE remained stable from 1999 to 2007 [APC: -0.2 %, (95 % CI: -2.0 to 0.5, p = 0.22)] and then significantly increased [APC: 3.1 % (95 % CI: 2.6 to 3.6), p < 0.0001], especially in males [AAPC: 1.9 % (95 % CI: 1.4 to 2.4), p < 0.001 vs AAPC: 1.5 % (95 % CI: 1.1 to 2.2), p < 0.001]. AAMR increase was more pronounced in those <65 years, Black Americans, and residents of rural areas.
In an US population analysis, high-risk PE mortality rate increased, with racial, sex-based, and regional variations. Further studies are needed to understand root causes for these trends and to implement appropriate corrective strategies.
美国（US）基于人群的高危肺栓塞（PE）死亡率趋势数据稀缺。
评估过去 21 年来 US 高危 PE 死亡率的当前趋势，并确定按性别、种族、民族、年龄和人口普查区域的差异。
从疾病控制和预防中心（CDC）的广泛在线流行病学研究（WONDER）中提取数据，以确定每 10 万人因高危 PE 导致的年龄调整死亡率（AAMR）的趋势。为了计算全国年度趋势，我们使用 Joinpoint 回归评估平均（AAPC）和年百分变化（APC）以及相对 95%置信区间（CI）。
1999 年至 2019 年间，高危 PE 被列为 209642 名患者的根本死因，对应的 AAMR 为每 10 万人 3.01（95%CI：2.99 至 3.02）。1999 年至 2007 年期间，高危 PE 的 AAMR 保持稳定（APC：-0.2%，95%CI：-2.0 至 0.5，p=0.22），然后显著增加（APC：3.1%，95%CI：2.6 至 3.6，p<0.0001），特别是在男性中（AAPC：1.9%，95%CI：1.4 至 2.4，p<0.001 与 AAPC：1.5%，95%CI：1.1 至 2.2，p<0.001）。在<65 岁、非裔美国人和农村地区居民中，AAMR 的增加更为明显。
在 US 人群分析中，高危 PE 死亡率增加，存在种族、性别和区域差异。需要进一步研究以了解这些趋势的根本原因，并实施适当的纠正策略。
