Trends in Pulmonary Embolism-related mortality in Europe

Key Takeaway

• This comprehensive analysis of data from the World Health Organization (WHO)’s Mortality Database shows that age-standardised pulmonary embolism (PE)-related mortality has been continuously declining in both women and men across all European subregions since 2000, possibly reflecting advances in prophylaxis and treatment.

• Despite this trend, PE remains an important contributor to total mortality, particularly among women aged 15-55 years.

Why This Matters

• Findings contribute to a significant correction of past mortality estimates and strengthen the basis for cause of death estimation of venous thromboembolic disorders.

• PE still represents a global problem. Therefore, continuing efforts are warranted to improve awareness and implement effective preventive and risk-adapted therapeutic measures.

Study Design

• Disease burden and time trends in PE-related mortality were assessed in the WHO European Region, covering a total population of >650 million by analysing the vital registration data from the WHO Mortality Database (2000-2015).

• Deaths were PE related if International Classification of Disease-10 code for acute PE (I26) or any code for deep or superficial vein thrombosis was listed as the primary cause of death.

• Proportionate mortality and time trends in age-standardised mortality were calculated using locally estimated scatterplot smoothing weighted by the size of the Member State population.

• Funding: German Federal Ministry of Education and Research.

Key Results

Between 2013 and 2015:

• On an average, 38,929 PE-related deaths occurred annually in the 41 member states with a population of 650,950,921 individuals.

• The age-standardised annual PE-related mortality rate was 6.8 (95% CI, 6.5-6.9) deaths per 100,000 population.

• PE was the primary cause of death in 7.5 (95% CI, 7.4-7.6) and 5.4 (95% CI, 5.4-5.5) cases per 1000 deaths in women and men (proportionate mortality), respectively.

• This difference was most prominent between 15 and 55 years of age.

• Among individuals aged 15-55 years, PE-related deaths accounted for 8-13 and 2-7 cases per 1000 deaths in women and men, respectively.

• Overall sex difference and age-specific peaks were less evident in Eastern Europe.

• PE-related mortality increased with age, with a seemingly exponential distribution.

From 2000 to 2015:

• The age-standardised annual PE-related mortality rate decreased from 12.8 (95% CI, 11.4-14.2) to 6.5 (95% CI, 5.3-7.7) deaths per 100,000 population.

• Joinpoint regression analysis showed a linear reduction in age-standardised PE-related mortality (annual change, –0.48 [95% CI, –0.52 to –0.43] deaths per 100,000 population), consistent between sexes.

• Time trend analysis by subregion revealed that the reduction was consistent across all subregions, except for Central Asia, which had an increasing trend.

Limitations

• The possibility of underestimation of PE-related mortality cannot be excluded.

• The number of diagnosed cases, necessary for estimating case fatality trends, was not provided in the database.

• Relevant geographical differences may exist in terms of quality of care, diagnostic algorithms, management and quality and completeness of data submitted to WHO.