Stefano Barco1, Seyed Hamidreza Mahmoudpour2, Luca Valerio3, Frederikus A Klok4, Thomas Münzel5, Saskia Middeldorp6, Walter Ageno7, Alexander T Cohen8, Beverley J Hunt9, Stavros V Konstantinides10. 1. Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany. Electronic address: s.barco@uni-mainz.de. 2. Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany; Institute for Medical Biostatistics, Epidemiology, and Informatics, University Medical Center Mainz, Mainz, Germany. 3. Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany. 4. Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany; Department of Internal Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands. 5. Center for Cardiology, University Medical Center Mainz, Mainz, Germany; German Center for Cardiovascular Research, Partner Site Rhine-Main, Rhine-Main, Germany. 6. Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands. 7. Department of Medicine and Surgery, University of Insubria, Varese, Italy. 8. Department of Haematological Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK. 9. St Thomas' Hospital Thrombosis and Haemophilia Centre and Thrombosis and Vascular Biology Group, Guy's and St Thomas' NHS Foundation Trust, London, UK. 10. Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
Abstract
BACKGROUND: European estimates of the burden imposed by pulmonary embolism are not available to this date. We aimed to assess pulmonary embolism-related mortality and time trends in the WHO European Region. METHODS: We analysed vital registration data from the WHO Mortality Database (2000-15) covering subregions of the WHO European Region: Eastern Europe, Northern Europe, Southern Europe, Western Europe, and Central Asia. Deaths were considered pulmonary embolism-related if International Classification of Disease-10 code for acute pulmonary embolism (I26) or any code for deep or superficial vein thrombosis was listed as the primary cause of death. We used locally estimated scatterplot smoothing weighted by size of the Member State population to calculate proportionate mortality and time trends in age-standardised mortality. FINDINGS: In the 3-year period between 2013 and 2015, an average of 38 929 pulmonary embolism-related deaths occurred annually in the 41 Member States with available data and a population of 650 950 921; among individuals aged 15-55 years, pulmonary embolism accounted for 8-13 per 1000 deaths in women and 2-7 per 1000 deaths in men. Between 2000 and 2015, age-standardised annual pulmonary embolism-related mortality rates decreased linearly from 12·8 (95% CI 11·4-14·2) to 6·5 (5·3-7·7) deaths per 100 000 population without substantial sex-specific differences. INTERPRETATION: The observed decreasing trends in pulmonary embolism-related mortality might reflect improved management of the disease, in line with case fatality data from cohort studies. Additional, or alternative, explanations might include the absence of a uniform case definition and changes in coding practices and performing autopsy. Pulmonary embolism still imposes a relevant medical and societal burden. Continuing efforts are warranted to improve awareness and implement effective preventive and therapeutic measures. FUNDING: German Federal Ministry of Education and Research.
BACKGROUND: European estimates of the burden imposed by pulmonary embolism are not available to this date. We aimed to assess pulmonary embolism-related mortality and time trends in the WHO European Region. METHODS: We analysed vital registration data from the WHO Mortality Database (2000-15) covering subregions of the WHO European Region: Eastern Europe, Northern Europe, Southern Europe, Western Europe, and Central Asia. Deaths were considered pulmonary embolism-related if International Classification of Disease-10 code for acute pulmonary embolism (I26) or any code for deep or superficial vein thrombosis was listed as the primary cause of death. We used locally estimated scatterplot smoothing weighted by size of the Member State population to calculate proportionate mortality and time trends in age-standardised mortality. FINDINGS: In the 3-year period between 2013 and 2015, an average of 38 929 pulmonary embolism-related deaths occurred annually in the 41 Member States with available data and a population of 650 950 921; among individuals aged 15-55 years, pulmonary embolism accounted for 8-13 per 1000 deaths in women and 2-7 per 1000 deaths in men. Between 2000 and 2015, age-standardised annual pulmonary embolism-related mortality rates decreased linearly from 12·8 (95% CI 11·4-14·2) to 6·5 (5·3-7·7) deaths per 100 000 population without substantial sex-specific differences. INTERPRETATION: The observed decreasing trends in pulmonary embolism-related mortality might reflect improved management of the disease, in line with case fatality data from cohort studies. Additional, or alternative, explanations might include the absence of a uniform case definition and changes in coding practices and performing autopsy. Pulmonary embolism still imposes a relevant medical and societal burden. Continuing efforts are warranted to improve awareness and implement effective preventive and therapeutic measures. FUNDING: German Federal Ministry of Education and Research.
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