11157 Background: Pulmonary embolism (PE) remains a major cause of preventable mortality, particularly among older adults with cancer who face heightened thrombotic risk. Understanding temporal trends in PE-related deaths is essential for guiding prevention and early detection. This study evaluates national patterns and racial disparities in PE-related mortality among older adults with neoplasms. Methods: We performed a retrospective cross-sectional analysis of the national death certificate data from the CDC's WONDER database. We included persons ≥65 years of age with neoplasms (ICD-10 code C00-D48) as the underlying cause of death and PE (ICD-10 code I26) as a contributing cause of death. The exposure variable was the year of death, and the outcome was PE-related age-adjusted mortality rate (AAMR) stratified by sex, race, rural-urban status, and census region. We calculated the PE-related AAMR in neoplasm per 100,000 population. Trends were evaluated with Joinpoint regression and expressed as an average annual percentage change (AAPC) with a 95% confidence interval (CI). P < 0.05 defined statistical significance. Results: Of 928 million people, 104,743 PE-related deaths occurred in older adults with neoplasms (AAMR 11.4). The AAMR was higher in males (13.3 vs 10.1 in females; P < 0.01), Black (17.0 vs 11.2 in White, P < 0.000001), and the Midwest census region (12.3 vs 11.7 in NorthEast, the Midwest, and 10.4 in the South; P < 0.0001). The AAMR was similar in rural areas (11.4 vs 11.3 in urban areas, P < 0.000001). The overall PE-related AAMR in neoplasms increased from 8.7 to 14.1 (AAPC 4.03%; CI: 3.12- 5.23). Furthermore, the AAMR increased in males (AAPC 3.37%; CI: 1.61-6.6) and females (AAPC 4.53%; CI: 3.15-6.20). Similarly, it increased in Black (AAPC 3.14%; CI:2.42-4.07), White (AAPC 3.98%; CI:3.07-5.14), rural (AAPC 3.70%; CI: 2.69-5.39), urban (AAPC 4.24; CI: 3.44-5.23 ), and across all geographic census regions. Conclusions: Pulmonary embolism related mortality among older adults with neoplasms has risen steadily over the past two decades across all demographic and geographic groups. Given that cancer-associated thrombosis is a well-recognized and largely preventable complication, these findings suggest important gaps in the prevention, recognition, and management of PE in oncology populations at the health-system level. The consistent upward trend highlights an urgent need to strengthen thromboprophylaxis strategies, risk stratification, and early detection efforts in older adults with cancer to reduce avoidable mortality.
Egwuonwu et al. (2026) studied this question.