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May 26, 2026Journal of Thrombosis and Thrombolysis0 citationsOpen Access

Temporal Trends and Future Projections of P ulmonary Embolism and Top Contributing Causes of death in the United States, 1968–2040: insights from the CDC WONDER database

SKSaifullah KhanFAFaizan AbbasMHMuhammad Hassan

Key Result

From 1968 to 2023, the overall age-adjusted mortality rate for pulmonary embolism in the US declined from 9.92 to 3.31 per 100,000 population (AAPC -1.85%).

Key Points

  • This research aims to assess the trends in pulmonary embolism mortality rates from 1968 to 2023 and project future rates until 2040 in the U.S.
  • Analyzed CDC WONDER death certificates for adults aged 25 and older.
  • Utilized age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) to evaluate trends.
  • Applied Auto-ARIMA and Prophet forecasting models for future projections.
  • From 1968-2023, 516,187 PE deaths with a mean AAMR of 6.06 per 100,000 (AAPC -1.85).
  • Projected AAMR of 3.63 by 2040, with 9.24 among adults ≥ 65 years.
  • Despite declines, persistent racial disparities in AAMRs with projections of 3.70 for White and 7.71 for Black individuals.

Study Design

Type

Observational (n=516,187)

Structured PICO

P
Population
Adults ≥ 25 years of age in the United States with pulmonary embolism (PE) listed as the underlying cause of death on death certificates from 1968 to 2023 (n=516,187 deaths).
O
Outcome
Age-adjusted mortality rates (AAMRs) per 100,000 population and annual percentage changes (APCs) of pulmonary embolism-related deathshard clinical

Despite a historical decline in pulmonary embolism mortality since 1968, rates are projected to rise by 2040, driven by aging populations, persistent racial disparities, and increasing cardiometabolic comorbidities.

Main Result

Effect estimate: AAPC -1.85% (95% CI -2.50 to -1.20)

Absolute Event Rate: 3.31% vs 9.92%

Limitations

  • Risk of misclassification or underreporting pulmonary embolism as a cause of death on death certificates
  • Higher use of electronic health records may inflate reported cases on death certificates
  • Absence of relevant data such as patients' socioeconomic status and laboratory findings
  • Cancer was not included among contributing causes due to heterogeneous ICD-10 coding
  • Forecasting models extrapolate recent trend structures and cannot account for unexpected future events or interventions
  • Forecasts represent trend-based extrapolations of historical mortality patterns rather than mechanistic predictions driven by future incidence
  • CDC WONDER does not provide incidence data and robust national incidence projections were not available for integration
  • Long-range sex-specific forecasts are inherently uncertain
  • Increasing documentation of cardiometabolic comorbidity on death certificates may reflect overall vascular risk burden rather than a direct causal relationship

Abstract

Pulmonary embolism (PE) is a preventable yet often deadly cardiovascular event. We aimed to investigate PE mortality trends from 1968-2023 and forecast rates through 2040 in the U.S. We analyzed CDC WONDER death certificates for adults ≥ 25 years. Age-adjusted mortality rates (AAMRs), annual percent changes (APCs) were used to analyse trends and Auto-ARIMA/Prophet forecasting models were used for future projections, all stratified by sex, age, race, and contributing cause of death. From 1968-2023, 516,187 PE deaths occurred, with a mean AAMR of 6.06 per 100,000 (AAPC -1.85). Mean AAMRs were 6.76 in men and 5.57 in women. By age, rates averaged 0.98 for adults 25-44 years, 3.96 for 45-64 years, and 21.73 for ≥ 65 years. Black adults had a mean AAMR of 10.87 versus 5.76 in White adults. From 1999-2023, PE death linked to Coronary Artery Disease, COPD, infection, and diabetes declined, while PE death linked to hypertension rose and heart failure related PE plateaued. Forecasts project an overall AAMR of 3.63 by 2040 (2.32 in men, 3.25 in women), with the highest predicted rate of 9.24 among adults ≥ 65 years. Projected racial AAMRs are 3.70 in White and 7.71 in Black individuals. Hypertension and heart failure linked rates are expected to rise further. Despite a sustained decline in PE death since 1968, persistent racial gaps, aging populations, and rising hypertension and heart-failure related PE threaten progress, highlighting the need for targeted prevention and equitable cardiovascular risk management.

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Cite This Study

Khan et al. (2026) conducted an observational in Pulmonary embolism mortality (n=516,187). Temporal observation (1968-2023) was evaluated on Age-adjusted mortality rate (AAMR) per 100,000 population (AAPC -1.85%, 95% CI -2.50 to -1.20). From 1968 to 2023, the overall age-adjusted mortality rate for pulmonary embolism in the US declined from 9.92 to 3.31 per 100,000 population (AAPC -1.85%).

synapsesocial.com/papers/6a153b00b5d9c58d83e8d388https://doi.org/10.1007/s11239-026-03281-9
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