Trends in pulmonary embolism-related deaths in Europe

Takeaway

• This comprehensive analysis of data from the WHO Mortality Database shows that age-standardised pulmonary embolism (PE)-related mortality has been continuously declining in both sexes across all European subregions since 2000, possibly reflecting advances in prophylaxis and treatment.
• Despite this trend, PE remains an important contributor to total mortality, especially among women aged 15–55 years.

Why this matters

• Findings contribute to an extensive 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

• Analysis of disease burden from PE and time trends assessed within the WHO European Region, covering a total population of >650 million, and a period of 16 years based on medically certified vital registration data from the WHO Mortality Database (2000-2015).
• Deaths were considered related to PE if the 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.
• Funding: German Federal Ministry of Education and Research.

Key results

• Between 2013 and 2015, the annual average number of PE-related mortality in the 3-year period was 38,929 in the 41-member states with the population amounting to an average of 650,950,921 individuals.
• PE-related deaths accounted for 8-13 cases per 1000 deaths in women and 2-7 cases per 1000 deaths in men among individuals aged 15-55 years.
• From 2000 to 2015, age-standardised annual PE-related mortality rate by locally estimated scatterplot smoothing decreased from 12.8 (95% CI, 11.4-14.2) to 6.5 (95% CI, 5.3-7.7) deaths per 100,000 population.
• From 2000 to 2015, the Joinpoint regression analysis showed a linear decrease in age-standardised PE-related mortality (annual change, –0.48 deaths per 100,000 population; 95% CI, –0.52 to –0.43), which was consistent between sexes.

Limitations

• Possibility of underestimating mortality related to PE cannot be excluded.