Mortality from Pulmonary Embolism in the United States Remarkable in Younger and Middle-aged Adults, and in Black People, International Study Shows
October 12th, 2020
Chapel Hill, NC, USA (13 October 2020) – A large epidemiological study focusing on mortality from acute pulmonary embolism (PE) in the United States (US) and Canada has been published today in The Lancet Respiratory Medicine.
A team of European and North American investigators led by Dr. Stefano Barco, MD, research group leader at the Center for Thrombosis and Hemostasis (CTH) of Mainz (Germany) and staff physician at the Clinic of Angiology of the University Hospital of Zurich (Switzerland), showed that for the first time in the past five decades the mortality related to PE in Canada has been plateauing after 2006, whereas it alarmingly increased in the US among younger and middle-aged adults aged 25-64 years.
The study, an update of the latest analysis of the burden of PE in the US published about twenty years ago, was based on vital registration data from the World Health Organisation (WHO) and the U.S. Centers for Disease Control and Prevention for the whole population of Canada and the United States in the period 2000-2018. For decennia, the academic world and society was used to announcements of successes in the fight against cardiovascular disease.
This is also the case for pulmonary embolism, one of the most important causes of cardiovascular mortality worldwide, which was characterized by a decreasing mortality in Europe, as showed by the same authors in a twin publication also published in Lancet Respiratory Medicine in 2019, and in North America over the past forty years and until a few years ago.
However, PE-related mortality plateaued in Canada, whereas it is increasingly causing deaths among young and middle-aged individuals in the US. The US negative trend is unique among high-income countries in the twenty-first century, and all the more alarming as it is accompanied by an overall decrease in life expectancy due to multiple reasons, including other cardiorespiratory syndromes, metabolic disorders and chronic system diseases.
How, then, should the results of the current study be interpreted, and what do they mean for patients and the healthcare systems?
“Several factors may have contributed to the new trend in the United States of America,” says Dr. Barco, first author of the study, “From a medical perspective we have observed an increasing prevalence of deaths due to PE associated with cancer, which now represents the most frequent comorbidity of PE patients in the US. One can also postulate that social inequalities and barriers to the access to healthcare played a major role. Newest medical technologies in diagnostics and treatment add little value at the population level, if they are not affordable or are used too late in a setting of inadequate prevention and unhealthy lifestyle, or simply if the awareness of the disease is low.”
In this perspective, the authors also demonstrated that PE-related mortality was higher (by up to 50%) in Black individuals than in White individuals, a gap that remains unmodified in comparison with 20 years ago and similar to that of other acute cardiovascular syndromes and chronic diseases.
A worrying at a time of continuing uncertainty and social burden as a consequence of the SARS-CoV2 virus pandemic. “Epidemiological studies do not use experimental data; therefore, they cannot provide any direct evidence for the causes of their findings,” adds Dr. Luca Valerio, MD, co-first author of the paper and lead biostatistician. “However, these findings are reliable because they are based on the totality of the medically verified death certificates produced in the two countries, and the data underwent extensive statistical validation.”
Prof. Beverley Hunt, MD, OBE, Chair of the World Thrombosis Day Steering Committee and co-author of this study, reinforced the key role of increasing awareness and improving care and research in venous thromboembolism (VTE):
“These alarming trends should prompt investigations in their root causes and immediate action by public health authorities. In 2020, PE should finally be included in estimates of global mortality to support continued efforts to ensure optimal prevention, early detection, and treatment.” The WHO has no programme to help reduce venous thromboembolism globally, particularly hospital-associated events. “The International Society on Thrombosis and Haemostasis (ISTH) and the World Thrombosis Day Committees,” continues Dr. Hunt, “are actively working with WHO’s patient safety group to meet this challenge.”
Louise St. Germain, Director of Marketing, Membership and Public Affairs, ISTH
Corresponding author of the study
Stefano Barco, MD, PhD, FESC
Clinic of Angiology, University Hospital Zurich, Zurich Switzerland
Stefano Barco, Luca Valerio, Walter Ageno, Alexander T Cohen, Samuel Z Goldhaber, Beverley J Hunt, Alfonso Iorio, David Jimenez, Frederikus A Klok, Nils Kucher, Seyed Hamidreza Mahmoudpour, Saskia Middeldorp, Thomas Münzel, Vicky Tagalakis, Aaron M Wendelboe, Stavros V Konstantinides. Age-sex specific pulmonary embolism-related mortality in the USA and Canada, 2000–18: an analysis of the WHO Mortality Database and of the CDC Multiple Cause of Death database. Lancet Respir Med. Published Online on October 12, 2020: https://doi.org/10.1016/S2213-2600(20)30417-3
Stefano Barco, Seyed Hamidreza Mahmoudpour, Luca Valerio, Frederikus A Klok, Thomas Münzel, Saskia Middeldorp, Walter Ageno, Alexander T Cohen, Beverley J Hunt, Stavros V Konstantinides. Trends in mortality related to pulmonary embolism in the European Region, 2000-15: analysis of vital registration data from the WHO Mortality Database. Lancet Respir Med. Published online on October 12, 2019. doi: https://10.1016/S2213-2600(19)30354-6