National Trends, Gender, Racial, and Regional Disparities in Pulmonary Embolism Mortality Before and After the COVID-19 Pandemic in the United States: Analysis from the CDC-Wonder Database, 2018–2023

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has increased mortality in the United States related to pulmonary embolism. (PE). Our study aims to (1) examine whether trends in PE mortality during the COVID-19 vaccination era reflect widening or narrowing of existing disparities; (2) characterize national trends in PE mortality from 2018 to 2023; and (3) quantify disparities in age-adjusted mortality by age, sex, race, region, and state. METHODS: We extracted death records spanning January 1, 2018, to December 31, 2023, from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. We used International Classification of Diseases, 10th revision codes to analyze age-adjusted mortality rates (AAMRs) and sociodemographic patterns by sex, race, region, and state. RESULTS: A total of 54,155 deaths were related to PE as the underlying cause of death from 2018 to 2023. The AAMR was 2.3 (per 100,000) population (95% confidence interval [CI], 2.3-2.4) in 2018, with a notable increase recorded in 2021 (2.5 per 100,000; 95% CI, 2.4-2.5). In 2022, the AAMR decreased to 2.3 (95% CI, 2.2-2.3). The highest AAMR remained among Black patients, peaking at 4.6 (95% CI, 4.4-4.8) in 2020-2021, which declined to 4.1 (95% CI, 3.9-4.3) in 2023, approximately double the rate in White adults (2.0; 95% CI, 2.0-2.1). Males had higher AAMR than females, although differences were not statistically significant (2023: males 2.2, 95% CI, 2.1-2.3; females 2.1, 95% CI, 2.0-2.1). Joinpoint regression revealed a consistent downward trend in COVID-associated PE mortality during the COVID-19 pandemic period (annual percentage change = -12.1%, P < 0.05), which suggests reduced PE mortality in individuals with COVID-19 in the postvaccination period. CONCLUSION: Our data indicated a modest national decline in PE mortality rates from 2018 to 2023 while substantial ethnic disparities persist. The Black population exhibited the highest overall AAMRs without measurable improvement over time. However, in PE deaths with concurrent COVID-19, Black-White disparities narrowed steadily from 2020 to 2023. Targeted interventions addressing racial, geographic, and socioeconomic disparities remain essential to improving PE outcomes.