Global trends in mortality related to pulmonary embolism: an epidemiological analysis of data from the World Health Organization mortality database from 2001 to 2023.

Background: Pulmonary embolism (PE) remains a major contributor to the global disease burden. However, disparities in international trends of PE-related mortality have not been comprehensively examined across geographic, economic, and healthcare system parameters. We employed multifaceted stratification to analyse long-term trends in PE-related mortality.

Methods: This epidemiological analysis used registration data from the World Health Organization Mortality Database. PE-related mortality was defined with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for acute PE (I26) and any forms of venous thromboembolism (I80, I822, I828, I829, O882, O222, O223, O229, O870, O871, and O879). Countries were deemed eligible for inclusion in the analysis if they provided mortality data for 5-year age intervals up to ≥85 years, from 2001 to 2023 (last update, February 2025). Countries with incomplete age- and sex-stratified demographic data were excluded. We used locally weighted regression (LOESS) to show global trends in crude and age-standardised mortality rates. Subgroup analyses by geographic region and income level were also performed. Additionally, joinpoint regression analysis was performed to estimate the average annual per cent change (AAPC) in the age-standardised mortality trends for each country during 2010-2023.

Findings: Data from 73 countries, encompassing 1,550,883 participants [57.8% (896,393) of whom were female], were eligible for the LOESS analysis, while those from 75 countries, including 915,518 participants (56.9% (520,587) of whom were female) were valid for the joinpoint analysis. The LOESS estimates of global age-standardised PE-related mortality rate (per 100,000) decreased from 3.49 (95% confidence interval [CI], 3.20-3.79) in 2001 to 2.42 (95% CI, 2.04-2.80) in 2023. The age-standardised mortality rates considerably reduced in European regions, such as Western Europe, from 5.24 (95% CI, 4.75-5.74) to 2.25 (95% CI, 1.62-2.87) in 2023; however, in Africa, they remained high from 4.23 (95% CI, 3.82-4.64) in 2001 to 3.90 (95% CI, 2.81-5.00) in 2023. High-income countries showed a continuous downward trend, from 3.68 (95% CI, 3.28-4.08) in 2001 to 2.20 (95% CI, 1.68-2.71) in 2023, whereas lower-to middle-income countries showed a rising trend, from 0.92 (95% CI, 0.04-1.81) in 2001 to 4.82 (95% CI, 3.12-6.52) in 2023. Higher increases in the age-standardised mortality rates were predominantly observed in lower-middle-income countries.

Interpretation: Globally, the PE-related mortality rate has declined over the last two decades, except in countries with certain geographical and economic conditions. Despite the potential limitation of misclassification and underreporting, our efforts corroborated that greater efforts are needed to reduce PE-related mortality, especially for populations in susceptible regions and lower-middle-income countries. A multi-layered approach will increase awareness of the disease and facilitate the development of healthcare policies that enhance its clinical management.

Funding: The Japan Society for the Promotion of Science, the Pfizer Health Research Foundation, and the Ohyama Health Foundation Inc.