Pulmonary embolism-related mortality in Northern America: age-sex differences, role of concomitant diseases and call for the recognition of pulmonary embolism as a global cause of death

In 2021, the role of pulmonary embolism (PE) as a primary cause of death is still debated: this condition has not been included in global analyses such as those from the Global Burden of Disease (GBD) initiative, which reports annually on almost 400 diseases and injuries. One year ago, an analysis of vital registration data from the WHO European region covering 41 countries and 650 million general population provided the first continent-wide estimates of PE-related mortality and suggested that PE still imposes a relevant medical and societal burden, despite decreasing trends.

In the study selected for this newsletter, a team of transatlantic experts from a wide range of specialties analysed data from Northern America, and in particular the Multiple Cause of Death database released annually by the Centers for Disease Control and Prevention, providing information on up to 15 causes of death on an individual patient level in the United States. As observed in Europe, PE-related mortality declined over the past 20 years in both Canada and the United States. The study, however, also showed that increasingly more young and middle-aged individuals have been dying of venous thromboembolism and its complications in recent years in the United States. This negative trend is a novelty among the wealthy industrial countries of the 21st century, but it is in line with what observed in other cardiovascular diseases, and may be explained by a combination of socio-economical inequalities and medical-epidemiological developments. Indeed, the authors also showed that PE-related mortality is still 50% higher in Black individuals than in White individuals and that, over the past 5 years, cancer became the most prevalent concomitant disease in those dying of PE. Pulmonary embolism still contributes disproportionately to the mortality burden of young and middle-aged women. The trends in autopsy use support the reliability of these figures and even suggest that they may even represent only the tip of the iceberg.

It is to hope that these alarming trends from the pre-COVID-19 era will prompt investigations in their root causes and consequent action by public health authorities. Indeed, the COVID-19 pandemics may have had a considerable impact on the general awareness of venous thromboembolism and resource allocation. In 2021, the inclusion of PE estimates of global mortality represents the first necessary step to ensure that strategies for optimal prevention, early detection, and effective treatment are put in place globally.